5,000 parents and teachers watched this. Hyderabad's academic pressure is producing a generation of teenagers with stress-related neurological symptoms — including pseudoseizures that look like epilepsy. Dr. Anand Karnam explains.
Key Points
- Functional neurological disorder (FND) is a real condition — the brain produces genuine neurological symptoms (seizures, paralysis, tremor) without structural damage, as a response to psychological stress.
- Pseudoseizures (non-epileptic attack disorder / NEAD) are caused by FND and represent the brain's physiological response to unbearable stress — not 'faking' or 'attention-seeking.'
- Board exam season and transition to Class 11 are consistently the highest-incidence periods for FND presentations in Hyderabad adolescents.
- Antiepileptic medication does not help pseudoseizures and can cause harm — correct diagnosis is essential before any treatment.
- Video-EEG monitoring is the gold standard diagnostic test that distinguishes epileptic seizures from non-epileptic attacks.
20–30%
of patients referred to epilepsy units have non-epileptic attacks (pseudoseizures)
Source: Epilepsy Foundation of India
68%
of adolescent FND cases in India occur in the context of exam stress or family conflict
Source: Indian Journal of Psychiatry 2022
1–3 yrs
average diagnostic delay for FND in India due to misdiagnosis as epilepsy
Source: NIMHANS Epilepsy Registry
"As a neurologist I see pseudoseizures in teenagers frequently during exam season. The most important thing parents must understand is that these events are genuine — the brain is producing real symptoms as a cry for help about psychological stress. It is not manipulation. And the treatment is psychological support and stress management, not antiepileptic drugs. Getting this diagnosis right completely changes the outcome."
In the weeks before board exams, competitive entrance exams (JEE, NEET), or during periods of intense academic pressure, Dr. Anand Karnam sees a specific cluster of presentations in Hyderabad's teenagers: daily headaches, sleep-onset insomnia, fatigue despite sleep, difficulty concentrating — and sometimes, episodes that look exactly like seizures but are not.
Why Stress Causes Physical Symptoms
Chronic psychological stress activates the body's sympathetic nervous system continuously — maintaining elevated cortisol and adrenaline. These stress hormones have direct physiological effects: muscle tension causing headache; dysregulated sleep architecture causing non-restorative sleep; gastrointestinal symptoms (nausea, irritable bowel); and altered pain thresholds making everything hurt more. These are not imagined — they are measurable biological changes driven by psychological stress.
What Are Pseudoseizures?
Psychogenic Non-Epileptic Seizures (PNES) — commonly called pseudoseizures — are episodes of involuntary movement, unresponsiveness, or altered consciousness that look clinically identical to epileptic seizures but are not caused by abnormal electrical brain activity. They are caused by a conversion of psychological distress into physical neurological symptoms — a process called functional neurological disorder.
PNES are more common in: adolescent females under intense pressure, patients with a history of trauma or emotional distress, and in settings with significant secondary gain (a seizure results in being taken home from school, being excused from exams). The episodes are real and involuntary — the person is not faking. But the mechanism is psychological, not epileptic.
How to Distinguish PNES from True Epilepsy
The gold standard is video-EEG monitoring — recording the EEG during an episode. In true epilepsy, there are characteristic electrical discharges during the event. In PNES, the EEG is normal during the episode. Clinical features that suggest PNES: episodes lasting much longer than typical epileptic seizures (20–30 minutes rather than 1–3 minutes); gradual onset rather than sudden; retained memory during the episode; episodes that occur exclusively in stressful situations; eyes closed during the episode (epileptic seizures typically produce eye opening).
Treatment of Stress-Related Neurological Symptoms in Teenagers
Addressing the underlying stress is the primary treatment. Medication for PNES is not effective unless depression or anxiety disorder is co-present and treated. Cognitive behavioural therapy (CBT) has the strongest evidence base. Academic pressure reduction, sleep prioritisation, regular exercise, and family communication are all important. The school and parents must understand that the symptoms are real, not performed.
Sri Anand CNC, Chanda Nagar, Hyderabad. Adolescent neurology and stress-related assessment. Call +91 90633 66983.
Dr. Anand Karnam
DrNB Neurology · Sri Anand CNC, Chanda Nagar Hyderabad · Sri Anand Child and Neuro Center
DrNB-qualified Neurologist, Fellow of the World Headache Society (FWHS), and Headache Specialist with 12+ years of experience treating epilepsy, stroke, migraine, and movement disorders. Practices at Sri Anand Child and Neuro Center, Chanda Nagar, Hyderabad.
References & Sources
- 1.Neurological Disorders — WHO — World Health Organization
- 2.Paediatric Neurology — AAP — American Academy of Pediatrics
- 3.IAP Neurology Guidelines — Indian Academy of Pediatrics
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