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

In this article focusing on patients with non-epileptic (functional) seizures (NES/FS), senior and rising academicians discuss lessons learned over decades of clinical practice, teaching, and research in the field. Lessons include that non-epileptic (functional) seizures (NES/FS) can be reliably differentiated from epilepsy and diagnosed by a trained neurologist/epileptologist using video EEG long-term monitoring in the seizure monitoring unit. We note that some patients have concurrent NES/FS and epilepsy, meaning that clinicians should carefully document each seizure and teach the patient to differentiate epileptic from non-epileptic events. Neuropsychiatric and neuropsychological evaluations can inform treatment in patients with NES/FS, particularly given the need to comprehensively assess and understand diverse neurological, psychiatric, cognitive, and medical symptoms. Finally, evidence-based psychotherapies for NES/FS include cognitive behavioral therapy and neurobehavioral therapy, which can be administered by a trained seizure counselor.