Functional Neurological Symptoms / PNES

Understanding Functional Neurological Symptoms and PNES

Some patients experience real neurological symptoms even when routine scans or tests do not show structural damage. These symptoms may include weakness, numbness, tremor, blackouts, seizure-like episodes, walking difficulty, speech difficulty, dizziness, abnormal movements, or extreme fatigue. FND & PNES Evaluation in Gurgaon may help when these symptoms remain unexplained or require careful neurological assessment.

Functional neurological disorder, or FND, refers to symptoms caused by a problem in nervous-system functioning rather than visible structural damage on routine tests. The symptoms are real. They are not fake, voluntary, or imagined.

PNES means psychogenic non-epileptic seizures. These are seizure-like episodes that are not caused by epileptic electrical discharges in the brain. They still require proper diagnosis, explanation, and treatment.

At JHN, we evaluate these symptoms carefully and respectfully. The goal is not to dismiss the patient. The goal is to understand the pattern, rule out important mimics, and guide the right treatment pathway.

Quick Check: Could This Be FND or PNES?

Patients may report:

• Seizure-like episodes
• Blackouts or unexplained spells
• Tremor or shaking episodes
• Weakness that varies over time
• Numbness or sensory symptoms
• Walking difficulty
• Imbalance
• Speech difficulty during episodes
• Sudden episodes triggered by stress, fatigue, pain, sleep loss, or emotional overload
• Symptoms that remain difficult to explain despite previous testing
• Conflicting opinions about epilepsy and non-epileptic events
• Events that continue despite seizure medication

Understanding FND and PNES

What Can Mimic FND or PNES?

Before labelling symptoms as functional, important neurological, cardiac, metabolic, sleep-related, and medical causes must be considered.

What to Expect at Your First Visit

Your first visit focuses on listening carefully to the symptom story. We will ask what happens before, during, and after the episodes; whether there are triggers; whether symptoms vary; what previous tests showed; what medicines have been tried; and how the symptoms affect daily life.

When to Seek Medical Evaluation

You should seek evaluation if you have:

• Recurrent seizure-like episodes
• Blackouts or unexplained spells
• Weakness, numbness, tremor, or walking difficulty without a clear diagnosis
• Events continuing despite seizure medication
• Conflicting opinions about epilepsy and PNES
• Symptoms affecting work, school, relationships, or daily function
• Anxiety, trauma, stress, sleep disruption, or burnout alongside neurological symptoms
• Need for EEG or video EEG correlation
• Concern that previous explanations were unclear, incomplete, or dismissive

When to Seek Urgent Care

How JHN Evaluates FND and PNES

Evaluation may include:

• Detailed symptom and event history
• Witness description
• Phone video review when available
• Neurological examination
• Review of previous MRI, CT, EEG, blood tests, prescriptions, and treatment records
• Screening for epileptic seizure features and non-epileptic event features
• Evaluation for fainting, sleep events, panic episodes, migraine, movement symptoms, and metabolic contributors
• EEG or video EEG when clinically appropriate
• ECG when syncope or cardiac concerns are possible
• Laboratory testing for metabolic contributors when needed
• NCV or EMG when neuropathy, radiculopathy, or nerve involvement is suspected
• Sleep study or PSG when sleep-related events or sleep apnea are suspected
• Referral to psychology, psychiatry, physiotherapy, or neurological rehabilitation when needed

Possible Tests and Referrals

Treatment Approach

Treatment depends on the confirmed diagnosis, symptom pattern, coexisting conditions, triggers, functional impact, and safety concerns.

• Clear explanation of the diagnosis and possible nervous-system mechanism
• Safety planning for seizure-like episodes, blackouts, falls, or weakness
• Avoiding unnecessary escalation of anti-seizure medicines when events are confirmed to be non-epileptic
• Treating coexisting epilepsy when both epilepsy and PNES are present
• Sleep correction and fatigue management
• Treatment of stress, anxiety, trauma, depression, or mood symptoms when relevant
• Psychology or psychiatry support
• Physiotherapy or neurological rehabilitation for movement, gait, tremor, or weakness symptoms
• Management of pain, migraine, sleep disorders, or other contributing medical conditions
• Follow-up to track episode frequency, triggers, daily function, treatment response, and safety

Safety Planning During Episodes

Living With More Than One Condition

Some patients with PNES or FND also have epilepsy, migraine, chronic pain, sleep disorders, anxiety, depression, neuropathy, or other medical conditions.

Ongoing care may involve coordination between neurology, sleep medicine, psychology, psychiatry, physiotherapy, rehabilitation, and general medical services depending on the patient’s needs.

Patient-Friendly Summary

Unexplained neurological symptoms should be understood, not dismissed. FND and PNES are real conditions that can cause weakness, tremor, blackouts, seizure-like episodes, walking difficulty, speech changes, and other disabling symptoms. FND & PNES Evaluation in Sector 56, Gurgaon can help with appropriate assessment and guidance.

Careful diagnosis helps rule out important mimics, prevents unnecessary treatment, and connects the patient with appropriate neurological, psychological, sleep, and rehabilitation support.