Clinical Report: AAN Issues Guideline on Functional Seizures

Overview

The American Academy of Neurology has released a guideline based on a systematic review indicating that psychological interventions, including cognitive behavioral therapy, may improve outcomes for patients with functional seizures. These interventions are associated with a higher likelihood of achieving seizure freedom compared to standard medical care.

Background

Functional seizures, a type of functional neurological disorder, can significantly impact patients' quality of life. Accurate diagnosis and effective management are crucial for improving patient outcomes. The new AAN guideline, developed through a systematic review of Class II and Class III studies, provides evidence-based recommendations to enhance the care of individuals experiencing functional seizures.

Data Highlights

Key Findings

• Psychological interventions are associated with improved seizure-related outcomes.
• Higher probability of achieving seizure freedom with psychological interventions (pooled risk ratio of 1.87).
• Lower functional seizure frequency observed with psychological interventions (pooled standardized mean difference of -0.81).
• Evidence for pharmacologic interventions is limited and confidence in estimates is very low.
• Guideline emphasizes the importance of accurate diagnosis and respectful communication with patients.
• Clinicians should avoid prescribing benzodiazepines or antiseizure medications for functional seizures without co-occurring epilepsy.

Clinical Implications

Clinicians should prioritize psychological interventions for patients with functional seizures, as these may lead to better outcomes compared to traditional medical approaches. It is essential to engage patients in shared decision-making, provide continuity of care, and ensure respectful communication.

Conclusion

The AAN guideline underscores the potential benefits of psychological interventions in managing functional seizures, advocating for a comprehensive and respectful approach to patient care, including accurate diagnosis and effective communication.

References

1. American Academy of Neurology: Neurology Resources | AAN, Neurology, 2025 -- AAN Issues Guideline on Functional Seizures
2. Brain — Iatrogenic Injury in Patients with Functional Neurological Disorder, Brain, 2023 -- Iatrogenic Injury in Patients with Functional Neurological Disorder
3. Intensive Care Medicine — Determining the Beneficiaries of Continuous EEG Monitoring in Critical Care Settings, Intensive Care Medicine, 2023 -- Determining the Beneficiaries of Continuous EEG Monitoring in Critical Care Settings
4. uci health — Epilepsy monitoring unit delivers clarity and confidence in care, UCI Health, 2023 -- Epilepsy monitoring unit delivers clarity and confidence in care
5. Can Acute Postoperative Seizures Serve as Predictors for Outcomes in Epilepsy Surgery? A Scoping Review
6. American Academy of Neurology: Neurology Resources | AAN
7. Management of Functional Seizures Practice Guideline Executive Summary: Report of the AAN Guidelines Subcommittee - PubMed