FND Education Project

REFERENCE · RECOVERY TECHNIQUE

Clinician-Taught Breathing Control for Functional Seizures

Most likely fit: When assessment identifies a breathing pattern that may be relevant and the person can practise comfortably between events. [Emerging evidence; a published randomized-trial protocol is not an efficacy result]

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Assessment before breathing exercises

Breathing control is a taught skill, not advice to take repeated huge breaths. The diaphragm is the broad breathing muscle beneath the lungs; the ribs and other breathing muscles also contribute. Hyperventilation means breathing more than the body needs, which can lower carbon dioxide. It is not the same as every episode of breathlessness and cannot be diagnosed from a feeling alone. [1][2][3]

Ask a respiratory physiotherapist or other suitably trained clinician whether this approach fits you. Heart or lung illness, sleep-related breathing problems and medication effects may need separate care. A familiar FND diagnosis does not explain away abnormal breathing or low oxygen.

What safe learning may involve

The clinician observes your usual breathing and helps find a comfortable, unforced pattern in a supported position. You agree how little practice to begin with and what would make you stop. There is no universal breath count, breath-holding target or required depth for this collection.

Use a taught cue at a familiar warning only if your plan includes it and you are alert enough. Do not use paper-bag breathing, intentional hyperventilation, forced breath-holding or painful cold stimulation. During impaired awareness or breathing distress, follow the safety plan rather than trying to complete an exercise.

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A gentle reminder may be useful if requested during safe practice. “Take a deep breath” repeated urgently can add pressure and may not match what was taught.

Do not press on the chest or abdomen, obstruct the airway, coach someone through unresponsiveness or assume a colour change is harmless. New or severe breathing difficulty needs medical help. Bring the written plan to appointments so advice is consistent.

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Explicit procedure and clinical anatomy

  1. Review cardiopulmonary history, medication, event pattern and reasons for dyspnoea (breathlessness); investigate red flags first.
  2. Assess respiratory rate, depth, thoracoabdominal coordination (how the rib cage and abdomen move together), accessory-muscle use and symptom response in a comfortable position.
  3. Explain the chosen approach without presenting hypocapnia (low carbon dioxide) as a demonstrated mechanism in every patient.
  4. Teach a comfortable pattern using individualized feedback within professional competence. Symptom questionnaires alone do not establish hyperventilation or rule out disease.
  5. Specify practice context, duration and stop criteria based on assessment rather than copying a generic ratio.
  6. Review dizziness, air hunger, dissociation, fatigue and delayed worsening; shorten, modify or stop as indicated.
  7. Integrate only a tolerable rehearsed cue into the warning plan, with an explicit no-warning and impaired-awareness fallback.

Evidence update

The 2024 uncontrolled pilot recruited 18 people; 10 completed follow-up. The seizure-frequency comparison did not reach conventional statistical significance. The 2026 scoping review describes limited, heterogeneous and indirect evidence. BREATHS published a randomized-trial protocol in 2026; that paper reports planned methods, not completed efficacy results. [1][2][3]

Track tolerability, respiratory symptoms and patient-selected function as well as episodes. There is no basis here for universal respiratory dosing or for promising that changing breathing will stop a seizure.

Basis and evidence boundary

Breathing remains an emerging option. The scoping review and protocol qualify the pilot rather than converting it into established treatment evidence. [1][2][3]

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Research and Sources

Citation Full citation and source
[1] Duncan R, Berlowitz DJ, Mullen S, et al. Breathing control training for functional seizures: a multi-site, open-label pilot study. Epilepsy & Behavior. 2024;154:109745. https://doi.org/10.1016/j.yebeh.2024.109745 FND-CIT-0034.
[2] Kanaan R, Duncan R, Mihalopoulos C, et al. Breathing control training as a treatment for functional seizures (BREATHS trial): a multicentre, assessor-blinded, randomised controlled efficacy and acceptability trial study protocol. BMJ Open. 2026;16(1):e107687. doi:10.1136/bmjopen-2025-107687 FND-CIT-0095.
[3] Zouki JJ, Ye H, Lo APK, et al. The therapeutic effect of breathing interventions for functional seizures: A scoping review. Epilepsy & Behavior. 2026;178:110919. doi:10.1016/j.yebeh.2026.110919 FND-CIT-0096.

Created September 14, 2026 · Neurology, relevant therapy, lived-experience, caregiver and accessibility review pending

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
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