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Functional Nonepileptic Seizures: Diagnosis, Comorbidity, Pathophysiology, and Management

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Abstract

Purpose of Review

The diagnosis and treatment of functional nonepileptic seizures are challenging, in part related to a lack of familiarity with the diagnosis, clinician discomfort with delivering the diagnosis, and a need for more effective and multidisciplinary treatment interventions. The purpose of this report is to describe relevant risk factors, diagnostic workup, comorbidity, proposed pathophysiological mechanisms, and management strategies.

Recent Findings

Advances in neuroimaging are shedding light on structural and functional differences in the brains of those living with functional nonepileptic seizures. Psychotherapy is the mainstay of treatment, but neuromodulation, e.g. repetitive transcranial magnetic stimulation (rTMS), may hold promise.

Summary

Functional nonepileptic seizures are a subtype of functional neurological disorder, formerly known as conversion disorder. An accurate diagnosis is often delayed, and the disorder is associated with higher rates of psychiatric complications, disability, and diminished quality of life. The underlying causes most likely include neural connectivity, psychological, and social factors. While treatment can be effective, access to expert care and nonadherence present barriers.

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Funding

Dr. Chadrick E. Lane is supported through an internal grant at UT Southwestern Medical Center/O’Donnell Brain Institute from the Peter O’Donnell Jr. Foundation. This funding amounts to $1,000,000 of research and salary support distributed over the course of 5 years.

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Authors and Affiliations

  1. Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA

    Moayad Reda Kabli

  2. Yale University School of Medicine, New Haven, CT, USA

    Siddharth Khasnavis

  3. Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA

    Chadrick E. Lane

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  1. Moayad Reda Kabli
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Correspondence to Chadrick E. Lane.

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Conflicts of Interest

Dr. Chadrick E. Lane serves on the professional advisory board for the Epilepsy Foundation of Texas. Dr. Siddharth Khasnavis does not have any conflicts of interest or competing interests to declare. Dr. Moayad Reda Kabli does not have any conflicts of interest or competing interests to declare.

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Kabli, M.R., Khasnavis, S. & Lane, C.E. Functional Nonepileptic Seizures: Diagnosis, Comorbidity, Pathophysiology, and Management. Curr Geri Rep 12, 69–74 (2023). https://doi.org/10.1007/s13670-023-00385-5

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