Development of a qualitative data analysis codebook for peri-ictal behavior in suspected functional seizures

Area of Science:

• Neurology
• Psychiatry
• Behavioral Science

Background:

• Identifying triggers for functional seizures is challenging.
• Understanding peri-ictal behaviors in naturalistic settings is crucial.

Purpose of the Study:

• To develop a methodology for investigating peri-ictal behaviors in functional seizures within the home environment.
• To operationalize the observation and coding of behaviors surrounding functional seizures.

Main Methods:

• An iterative, four-phase process was used to develop a codebook for peri-functional seizure behavior.
• Observations of 37 functional seizures across 14 participants were conducted.
• A multidisciplinary panel refined code definitions, and the codebook was piloted on 20 events.

Main Results:

• A final codebook was developed, identifying five key factors: body position, activity, behavior, interaction, and number of bystanders.
• Exploratory analysis indicated a significant positive correlation between the number of bystanders during the ictal phase and seizure duration (r = .61, p = .004).

Conclusions:

• This study demonstrates the feasibility of studying functional seizure behavior in home environments.
• The developed codebook can enhance understanding of peri-ictal influences on functional seizures.
• Findings can inform evidence-based management strategies for functional seizures.