Can PNES Kill You?
PNES itself does not directly cause death because these episodes lack the abnormal electrical brain activity that creates life-threatening complications like status epilepticus, severe hypoxia, aspiration, or cardiac arrhythmias seen in true epileptic seizures 1.
Direct Mortality Risk: Essentially None
PNES episodes involve motor, sensory, mental, or autonomic manifestations that mimic epileptic seizures but lack epileptogenic brain activity, meaning there is no abnormal electrical discharge that could cause life-threatening complications 1.
Episodes typically last less than 30 seconds and do not cause the prolonged cerebral dysfunction, severe hypoxia, aspiration, or cardiac arrhythmias that can lead to death during true epileptic activity 1.
The physiological sequelae of true seizures—which can be fatal—simply do not occur with PNES 1.
Indirect Mortality Risk: The Real Danger is Misdiagnosis
The actual mortality risk from PNES comes from being misdiagnosed as epilepsy and receiving aggressive, unnecessary treatments that can kill you 1, 2.
Iatrogenic Complications from Misdiagnosis
When PNES is mistaken for status epilepticus, patients receive benzodiazepines, propofol, and other sedatives that cause respiratory depression, cardiac complications, and CNS adverse effects—potentially requiring intubation and mechanical ventilation 1.
Studies show that 8 of 10 PNES patients were inappropriately prescribed anticonvulsants, 6 received anticonvulsants in the emergency department, and nearly all underwent invasive procedures and testing 1.
Aggressive treatment of presumed status epilepticus in PNES patients can lead to iatrogenic complications, including respiratory failure from medications that are standard for true seizures but unnecessary and dangerous in PNES 1, 2.
PNES emergencies (sometimes called "nonepileptic psychogenic status" or NEPS when prolonged) are associated with serious iatrogenic complications, including death, when patients receive aggressive medical treatments 2.
Additional Indirect Risks
Accidents and injuries during PNES episodes are an underrecognized source of morbidity 2.
PNES during pregnancy may be misdiagnosed as eclampsia, leading to premature delivery and exposure to medications harmful to the fetus 2.
The challenge is compounded when patients have both true epilepsy and PNES coexisting, making treatment decisions complex and potentially life-threatening if the wrong condition is treated 1.
How to Prevent Mortality
Accurate diagnosis through video-EEG monitoring is critical to prevent harmful treatments 1, 3.
Video-EEG monitoring is the gold standard, capturing typical events with continuous monitoring to show normal EEG during PNES episodes (versus epileptiform discharges in true seizures) 3.
Once PNES is diagnosed, avoid unnecessary anticonvulsants and invasive procedures, as these interventions carry risks without providing benefit 1.
Early psychiatric referral is essential, as 72% of PNES patients showed resolution after psychiatric treatment in follow-up studies 4.
Cognitive behavioral therapy (CBT) is the first-line treatment for PNES, while pharmacotherapy has no demonstrated benefit for PNES itself 4.