Evaluation and management of non-epileptic (functional) seizures: Lessons learned

Area of Science:

• Neurology
• Psychiatry

Background:

• Non-epileptic seizures (NES/FS), also known as functional seizures, present diagnostic and therapeutic challenges.
• Decades of clinical practice, teaching, and research offer valuable insights into managing NES/FS.

Purpose of the Study:

• To share key lessons learned in the diagnosis and management of non-epileptic seizures (NES/FS).
• To highlight the importance of differentiating NES/FS from epilepsy and the role of specialized evaluations and therapies.

Main Methods:

• Expert consensus and clinical experience in diagnosing and treating patients with NES/FS.
• Utilizing video electroencephalogram (EEG) long-term monitoring for accurate diagnosis.
• Incorporating neuropsychiatric and neuropsychological assessments.
• Applying evidence-based psychotherapies.

Main Results:

• Non-epileptic seizures (NES/FS) can be reliably differentiated from epilepsy by trained neurologists using video EEG monitoring.
• Some patients may have both NES/FS and epilepsy, necessitating careful documentation and patient education.
• Neuropsychiatric and neuropsychological evaluations are crucial for comprehensive patient assessment.
• Evidence-based psychotherapies, including cognitive behavioral therapy and neurobehavioral therapy, are effective treatments for NES/FS.

Conclusions:

• Accurate diagnosis of NES/FS is achievable through specialized clinical methods.
• Integrated treatment approaches, combining neurological and psychiatric care, are essential for optimal outcomes in NES/FS patients.
• Psychotherapy plays a vital role in managing non-epileptic seizures (NES/FS).