Due to the high prevalence of epilepsy, the public is somewhat informed about its typical clinical picture. However, from a diagnostic standpoint, it is crucial to consider that not every paroxysmal event is the result of pathological electrical activity in the central nervous system.<\/p>\n
Functional Seizures (FS), formerly known as psychogenic non-epileptic seizures (PNES), closely mimic “real” seizures in their manifestation, yet their etiology is entirely different. A functional seizure is essentially a psychosomatic event manifested by dissociation between the mind and the body, often resulting from severe stress or traumatic experiences. Due to this psychogenic nature, it belongs to the group of Functional Neurological Disorders (FND), emphasizing that the symptoms are real and do not represent conscious simulation.<\/p>\n
Despite the prevalence of functional seizures ranging from 2 to 33 cases per 100,000 population, the diagnostic process is often delayed for years (averaging 7 years). A late diagnosis and subsequent misclassification lead to the inappropriate treatment of patients with Anti-Seizure Medications (ASM). Against the backdrop of widespread stigma and diagnostic gaps, the first official guideline published by the American Academy of Neurology (AAN) serves as the foundation for systemic change.<\/p>\n
The AAN guideline is based on a systemic review of 12 studies (Class II-III) from Medline, Embase, PsychINFO, and CINAHL. Using GRADE<\/a> and Delphi<\/a> methods, the assessment of evidence highlighted the superiority of psychological interventions over standard medical care, specifically regarding seizure frequency, quality of life (QoL), and functional\/psychiatric status.<\/p>\n Key Recommendations<\/strong><\/p>\n Diagnostics: Immediate and Accurate Identification (Level B\/C)<\/strong><\/p>\n The cornerstone of management is the correct differentiation of FS. This process begins with a detailed history from the patient and witnesses, and the study of semiology through video footage.<\/p>\n The “Gold Standard” of diagnosis is Video-Electroencephalogram (Video-EEG), which confirms normal electrical brain activity during an episode. To rule out syncope, cardiac investigations, including ECG and Tilt-Table tests<\/a>, are mandatory.<\/p>\n Psychiatric Comorbidities: A Holistic Approach (Level B)<\/strong><\/p>\n Management involves active screening for mental health disorders such as anxiety, depression, or PTSD. Untreated comorbid conditions directly hinder the effectiveness of FS management and the patient’s recovery process.<\/p>\n Coexistence of Epilepsy: Differentiated Therapy (Level B)<\/strong><\/p>\n Since the coexistence rate of epilepsy in patients with FS is high (approximately 20% in adults), differentiated screening is necessary. Clinicians must inform patients that ASM therapy is effective only in cases of confirmed epilepsy to avoid unnecessary risks.<\/p>\n General Management: A Multidisciplinary Approach (Level B)<\/strong><\/p>\n The collaboration between neurologists and mental health specialists is vital. This cooperation begins at the stage of sharing the diagnosis, which must be clear, empathetic, and patient-centered to facilitate shared decision-making.<\/p>\n Psychological Support: First-Line Treatment (Level B)<\/strong><\/p>\n Psychotherapeutic interventions are the first line of treatment. Patients should be referred to specialists for:<\/p>\n Cognitive Behavioral Therapy (CBT) and neurobehavioral therapy focused specifically on seizure management.<\/p>\n