Provocative techniques for functional/dissociative seizure: the colored pad test - a safe and reliable procedure

Area of Science:

• Neurology
• Clinical Neurophysiology

Background:

• Video-electroencephalography (video-EEG) monitoring is crucial for diagnosing functional/dissociative seizures (FDS).
• A standardized protocol for suggestive seizure induction during video-EEG is lacking.
• Colored cotton pads offer a novel method for seizure induction and suppression testing.

Purpose of the Study:

• To describe and evaluate a novel induction/suppression test using colored cotton pads for diagnosing FDS.
• To assess the feasibility, effectiveness, and safety of this method in routine clinical practice.

Main Methods:

• Retrospective review of the cotton pad induction/suppression test in patients with suspected FDS (February 2016 - July 2024).
• Detailed description of the technical procedure.
• Comparison of patients with positive (T+) versus negative (T-) induction tests.

Main Results:

• An FDS episode was induced in 63.1% (82/130) of patients.
• Patients with positive induction tests had significantly lower schooling levels (p=0.016).
• The suppression phase effectively terminated induced FDS in 96.3% (79/82) of patients.

Conclusions:

• The cotton pad induction/suppression test is a feasible, effective, safe, and ethical method for diagnosing FDS.
• This technique provides a standardized approach to suggestive seizure induction.
• The method aids in documenting FDS during video-EEG monitoring.