Paroxysmal spells are sudden, short-lived events that appear out of nowhere—often terrifying, confusing, and hard to describe. They might look like seizures, fainting, strange body movements, or sudden emotional shifts. But they’re not always what they seem. Many paroxysmal spells aren’t seizures at all.

These episodes can affect people with neurological conditions, psychiatric diagnoses, developmental disabilities, and chronic illnesses.

The Basics: What “Paroxysmal” Means

“Paroxysmal” comes from the Greek word paroxysmos, meaning “a sudden attack or outburst.” It refers to episodes that:

• Start abruptly

• Last briefly (seconds to minutes)

• Resolve spontaneously

• Often repeat in patterns

These spells can involve motor symptoms (like jerking), sensory changes (like tingling or déjà vu), emotional surges, or even loss of consciousness.

Paroxysmal Spells vs. Seizures: What’s the Difference?

Not all sudden neurological events are seizures. Some paroxysmal spells may look like epilepsy, but they’re caused by other things—like movement disorders, heart conditions, trauma responses, or psychiatric illness.

Paroxysmal spells may include:

• Psychogenic non-epileptic seizures (PNES)

• Tics or stereotypies

• Drop attacks

• Sleep-related behaviors (e.g., parasomnias)

• Syncope (fainting)

• Vestibular migraines

• Spasticity or dystonia flares

• Anxiety or panic attacks

Key Differences:

Common Types of Paroxysmal Spells

Here are some of the most common—and misunderstood—paroxysmal spells people experience:

1. Psychogenic Non-Epileptic Seizures (PNES)

These are seizure-like episodes not caused by abnormal electrical activity but by psychological stress, trauma, or dissociation. They can look just like tonic-clonic seizures, but EEGs are typically normal.

People may experience:

• Jerking or stiffening

• Crying or vocalizing

• Unresponsiveness

• Prolonged confusion

Often linked with PTSD or anxiety. People aren’t “faking”—these are real, distressing events.

2. Syncope (Fainting)

A brief loss of consciousness due to a sudden drop in blood flow to the brain. It can look like a seizure, especially if there’s some twitching during the collapse.

Possible triggers include:

• Standing too long

• Pain or fear

• Dehydration or overheating

• Heart rhythm issues

3. Paroxysmal Movement Disorders

People with conditions like Parkinson’s disease, cerebral palsy, or even no diagnosed disorder may experience sudden dystonic postures, tremors, or myoclonic jerks.

Vestibular disorders like Meniere’s disease can also cause paroxysmal vertigo spells—spinning, imbalance, and nausea.

4. Tics or Stereotypies

In people with autism, Tourette syndrome, or developmental disabilities, repetitive movements or sounds may suddenly flare up.

Examples include:

• Eye blinking

• Head jerking

• Vocal outbursts

• Hand flapping

These may intensify with excitement, anxiety, or fatigue.

5. Paroxysmal Emotional Spells

People with mood or trauma-related conditions may experience intense, sudden emotional episodes that feel out of control.

These might involve:

• Sudden rage or crying

• Panic attacks

• Dissociation or detachment from the body

• Intrusive trauma memories or flashbacks

These events are often misinterpreted as behavioral issues or “fits,” especially in children or non-speaking individuals.

Why Are These Spells So Hard to Diagnose?

Because they’re brief, unpredictable, and often invisible on tests, paroxysmal spells can leave patients feeling gaslit or dismissed. They fall into the gray zone between neurology and psychiatry, and even specialists can disagree on what’s going on.

Diagnosis may require:

• Video EEG monitoring

• Holter monitor (for heart-related causes)

• Psychiatric evaluation

• Sleep studies

• Functional neurologic assessment

Many people go years without answers. That’s frustrating and exhausting—but you are not alone.

What Should You Do If You Experience Paroxysmal Spells?

Here’s a human-centered approach to navigating these episodes:

1. Keep a log.

Track when spells occur, what happened before, how long they lasted, and how you felt afterward. Use video recordings if possible (with consent).

2. Get a multidisciplinary evaluation if that’s accessible to you.

This could include a neurologist, psychiatrist, cardiologist, and/or movement disorder specialist. Some spells don’t fit neatly into one specialty.

3. Be kind to yourself.

Paroxysmal spells are not your fault. They’re not made up or “just stress.” Your body is reacting in real time to something complex. You deserve care.

Living with Paroxysmal Spells

These episodes can interfere with work, school, driving, and daily life. For many people, the uncertainty is the hardest part. If you’re living with paroxysmal spells:

• Advocate for thorough testing, but trust your experience even when labs are normal.

• Connect with others who’ve been through it—online groups or disability communities.

• Focus on stress management and support, even while still figuring out the root cause.

• Keep medical records organized and bring someone to appointments if possible.

You’re Not Alone in the Mystery

Paroxysmal spells remind us that not everything in medicine fits into clean categories. These episodes can be frightening, disruptive, and deeply misunderstood—but they are real, and your experience matters.

If you’re navigating paroxysmal spells, know that many others are, too. Keep asking questions. Keep pushing for answers. And above all, treat yourself with the same compassion you’d offer a friend in the same boat.