Which statement best describes non-epileptic seizures (PNES) in contrast to epileptic seizures?

• A. PNES always involve epileptiform activity on EEG.
• B. PNES resemble seizures with epileptic activity present on EEG.
• C. PNES are events that resemble seizures but show no epileptic activity on EEG and can be a manifestation of Functional Neurological Symptom Disorder.
• D. PNES are identical to epileptic seizures in all clinical features.

Answer: (C)

Non-epileptic seizures are events that look like seizures but do not arise from abnormal brain electrical activity. During an PNES event, the EEG does not show ictal epileptiform discharges, which is why video-EEG monitoring is the gold standard to distinguish PNES from epileptic seizures. These events are considered manifestations of Functional Neurological Symptom Disorder (conversion disorder): real, distressing experiences that reflect altered nervous system function rather than an epileptic brain process, often linked to psychological factors or stress. Management emphasizes education, psychotherapy, and rehabilitation rather than antiseizure medications alone.

So the best description is that PNES resemble seizures but show no epileptic activity on EEG and can be a manifestation of Functional Neurological Symptom Disorder.