Low-intervention care and duration of functional seizures: An exploratory study

This exploratory study aims to explore whether a calm and safe environment, minimal external stimuli, and neutral behavior of bystanders and medical personnel may contribute to shorter functional seizure (FS) duration.

This exploratory study included adults with documented-FS first diagnosed between December 2024 and August 2025. During seizures, only observation or minimal intervention to prevent harm was performed; no external stimuli (e.g., physical contact, manipulations, or forced head or body turning) were applied. Demographic and seizure-related data, healthcare utilization in the three months before diagnosis, and prospective 3-month follow-up data on seizure occurrence, duration, Emergency Medical Services (EMS) calls, and hospitalizations were collected.

Twenty-one patients with documented-FS were included. Hypermotor seizures were the most frequent subtype, observed in 12 patients (57%). Headache, often migraine, was reported as a common trigger for seizures by 67%. The most frequently reported actions prior EMU were turning the patient onto their side (to presumably protect the airway), which was done in 18 patients (85.7%), and massaging or shaking the limbs/body to "stimulate" the patient, reported in 17 patients (81%), splash water (11 patients, 52.4%), restraining the patient's movements occurred in 10 patients (47.6%).The median reported duration of a typical seizure was 20 min (IQR 11.5-40 min) decreased to approximately 7 min (IQR 4-10 min), and to 8 min (IQR 5-10 min) post-Epilepsy Monitoring Unit (EMU) period. Patients frequently contacted EMS in response to their seizures, with a median of 11 calls (IQR 8-24), EMS calls by relatives (familiar with the diagnosis) dropped to 0 (IQR 0-1).

In this exploratory study, FS recorded under calm, non-intervening conditions in the EMU were consistently shorter than patients' habitual seizures, and diagnosis combined with structured counseling was associated with marked reductions in emergency service use and hospitalizations.