Paediatricians' attitudes to and management of functional seizures in children
Eva Skovslund Nielsen1, Bianca Taaning Wichaidit2, John Rosendahl Østergaard3
1Aarhus University, Nordre Ringgade 1, 8000, Arhus C, Denmark.
Insights
Paediatricians often believe functional seizures (FS) are psychogenic and can diagnose them by observation alone, but desire clinical guidelines and better treatments. Improved training and collaboration with child mental health services are recommended for this disabling disorder.
Area of Science:
- Neurology
- Child and Adolescent Psychiatry
- Pediatrics
Background:
- Functional seizures (FS) present diagnostic and management challenges in pediatric care.
- Understanding paediatricians' perspectives is crucial for improving care pathways.
Purpose of the Study:
- To investigate paediatricians' attitudes towards and treatment practices for children experiencing functional seizures.
- To identify needs for clinical guidelines and enhanced treatment options.
Main Methods:
- A nationwide survey was conducted among Danish neuro-paediatricians and social paediatricians.
- A structured questionnaire addressed aetiology beliefs, diagnostic approaches, management strategies, and perceived needs.
Main Results:
- High participation (95%) revealed diverse beliefs, with 65% favoring psychogenic aetiology and 57% relying solely on seizure observation for diagnosis.
- A significant majority (78%) desired clinical guidelines, and only 13% found existing treatments adequate.
- Collaborative care models were favored, yet only 23% frequently referred patients to child and adolescent mental health services (CAMHS).
Conclusions:
- Clinical guidelines are urgently needed to standardize the understanding, assessment, and management of functional seizures in children.
- Enhanced training for paediatricians and improved collaboration with CAMHS are essential for addressing this challenging disorder.
Objective:
To explore paediatricians' attitudes to and treatment practice for children with functional seizures (FS).
Methods:
In a nationwide survey, all 64 Danish neuro-paediatricians and social paediatricians were invited to complete a structured questionnaire encompassing FS-related issues that included beliefs and attitudes about aetiology and diagnostic assessment, current strategies for management, experienced need for clinical guidelines and better treatment options.
Results:
A total of 61 paediatricians (95%) participated in the study. Nearly half (46%) had seen more than 30 children with FS during their career. Most (65%) believed in a primarily psychogenic aetiology. More than half (57%) stated that they could make the diagnosis by solely observing a seizure, and 18% indicated the children faked their symptoms. The paediatricians' responses to these issues did not significantly vary according to their level of clinical experience. Furthermore, the majority (78%) expressed a need for clinical guidelines, and only 13% rated existing treatment options as sufficient. Collaborative care between different specialties or management in a child and adolescent mental health services (CAMHS) setting was seen as the best model for treatment. However, only 23% reported often referring these children to CAMHS after making the diagnosis.
Conclusion:
The findings suggest that introduction of clinical guidelines in this area is highly needed. Such guidelines could promote more formal training of paediatricians in understanding and assessing FS and increased collaboration between paediatrics and CAMHS regarding care for children with this challenging and potentially costly and disabling disorder.
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