Primum non nocere: Endotracheal Intubation for Prolonged Functional/Dissociative Seizures in an Adolescent

Functional/dissociative seizures (FDS) are one of the most common manifestations of functional neurological disorder (FND) in both adult and pediatric populations. FND and FDS result in significant healthcare utilization and costs, often due to excessive medical interventions and workup. Previously regarded as a diagnosis of exclusion that required extensive testing to identify, FND and FDS are now more accurately understood as "rule-in" diagnoses, based on the presence of characteristic positive clinical findings. Early identification and evidence-based therapies can facilitate patient recovery. However, patient outcomes continue to be negatively affected by clinicians' limited familiarity and comfort with this diagnosis. We describe the case of an adolescent with FDS who was intubated and admitted to the intensive care unit for presumed convulsive status epilepticus, and who has since had resolution of FDS after treatment by an interdisciplinary team. Our goal is to highlight the need for increased training of healthcare personnel in the recognition and management of this important clinical entity to facilitate early diagnosis, improve clinical outcomes, and potentially decrease healthcare utilization.