Inappropriate prescribing of antiseizure medications in people with functional seizures: A call to action

People with functional seizures (FS) experience an average diagnostic delay of six to nine years. During that time, they are often exposed to antiseizure medications (ASMs) and may be erroneously classified as having drug-resistant epilepsy. This has broad and negative impacts on individuals, health systems, and clinical research. This study investigates the burden of ASM prescriptions among people with FS and associated factors leading to their inappropriate use.

Retrospective analyses were conducted utilizing data from 505 people referred to a single FS clinic between July 2020 and July 2023 who had reported exposure to at least one prior ASM. The total number of ASMs were analyzed across patient demographics and associations between medical comorbidities and ASMs were assessed. Post-hoc tests were performed to investigate pairwise relationships.

Of all FS clinic attendees, 67% reported at least one prior ASM prescription with a median number of two ASM trials. The majority (65%) did not have comorbid epilepsy. Most were Caucasian, unemployed, and utilizing income-based government insurance (i.e. Medicaid). Levetiracetam was the most prescribed ASM across diagnoses, especially for people with FS alone. Longer diagnostic delays, older age, a dual diagnosis of FS plus epilepsy, and markers of social vulnerability, including unemployment, government-sponsored insurance and disability compensation were all factors associated with a higher number of ASM trials.

This study highlights inappropriate ASM prescribing in the FS population, especially in vulnerable disabled individuals. There is an urgent need for improved prescriber awareness of FS due to its broad implications on the health of individuals, costs to healthcare systems, and impact on clinical research.