Executive function in functional/dissociative seizures: screening using the frontal assessment battery

Functional/dissociative seizures (FDS) are episodes of seizure-like behavior with a biopsychosocial basis. Emerging evidence has suggested executive dysfunctions in individuals with FDS. The Frontal Assessment Battery (FAB) has been widely used to assess executive functioning in neurologic conditions.

We aimed to characterize FAB performance and executive screening profiles in FDS and to evaluate case-control differences between individuals with FDS and healthy controls.

This study included individuals referred to epilepsy clinics affiliated with Tehran University of Medical Sciences who were diagnosed with FDS. Independent-samples t-tests were used to compare FAB scores between healthy controls and individuals with FDS. Moreover, receiver operating characteristic (ROC) curve analysis was conducted to assess the discriminative performance of the FAB.

50 healthy individuals and 50 with FDS were recruited in this study. The mean FAB score was significantly lower in individuals with FDS than in healthy controls (p < 0.001). Similar differences between these groups were observed in most FAB subdomains, including conceptualization, mental flexibility, motor programming, sensitivity to interference, and inhibitory control (p < 0.001). In the FDS group, FAB scores were positively associated with years of education (B = 0.222, p = 0.002). Finally, the FAB demonstrated strong case-control discriminative performance between individuals with FDS and healthy controls (AUC = 0.909, 95 % CI: 0.847 to 0.962).

In conclusion, the FAB may serve as a practical bedside screening measure for executive dysfunction in FDS. Further studies are needed to evaluate its clinical utility in differentiating FDS from epileptic disorders.