On average, it takes seven years to receive a proper diagnosis. The differential diagnosis of PNES firstly involves ruling out epilepsy as the cause of the seizure episodes, along with other organic causes of non-epileptic seizures, including syncope, migraine, vertigo, anoxia, hypoglycemia, and stroke. However, 5–20% of people with PNES also have epilepsy. Frontal lobe seizures can be mistaken for PNES, though these tend to have shorter duration, stereotyped patterns of movements, and occurrence during sleep. Next, an exclusion of factitious disorder (a subconscious somatic symptom disorder, where seizures are caused by psychological reasons) and malingering (simulating seizures intentionally for conscious personal gain – such as monetary compensation or avoidance of criminal punishment) is conducted. Finally other psychiatric conditions that may superficially resemble seizures are eliminated, including panic disorder, schizophrenia, and depersonalisation disorder.The most definitive test to distinguish epilepsy from PNES is long term video-EEG monitoring, with the aim of capturing one or two episodes on both video recording and EEG simultaneously (some clinicians may use suggestion to attempt to trigger an episode). Additional clinical criteria are usually considered in addition to video-EEG monitoring when diagnosing PNES. By recording the event in question on video and EEG simultaneously, a clear diagnosis can usually be obtained.Laboratory testing can detect rising blood levels of serum prolactin if samples are taken in the right time window after most tonic-clonic or complex partial epileptic seizures. However, due to false positives and variability in results, this test is relied upon less frequently.
Eight points recommended to explain the diagnosis to the person and their caregivers are:

Reasons for concluding they do not have epilepsy
What they do have (describe FND)
Emphasize they are not suspected of "putting on" the attacks, and the symptoms are not "all in their head"
There may be no triggering "stresses"
Maintaining factors
May improve after correct diagnosis
Caution that anticonvulsant drug withdrawal should be done in conjunction with their physician
Describe treatment to help regain control of symptomsPsychotherapy is the most frequently used treatment, which might include cognitive behavioral therapy or therapy to retrain the physical symptoms and allow the individual to regain control of the attacks (ReACT). There is also some evidence supporting selective serotonin reuptake inhibitor antidepressants.Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) treatments for PNES typically target fear avoidance and work to reattribute patients symptoms to psychosocial issues. Retraining and Control Therapy (ReACT)
ReACT, while new and understudied, has shown extremely promising outcomes for reduction of PNES episodes in pediatric patients. This therapy focuses on the idea that PNES are caused by a learned physical reaction or habit the body develops, similar to a reflex. ReACT aims to retrain the learned reaction (PNES episodes) by targeting symptom catastrophizing and restoring sense of control over symptoms. Prognosis
Though there is limited evidence, outcomes appear to be relatively poor with a review of outcome studies finding that two thirds of people with PNES continue to experience episodes and more than half are dependent on the Social Security program at three-year follow-up.