Clinical Scorecard: AAN Issues Guideline on Functional Seizures

At a Glance

Key Highlights

• Psychological interventions increase the probability of seizure freedom.
• Pooled risk ratio for seizure freedom with psychological interventions is 1.87.
• Functional seizure-specific CBT shows a pooled risk ratio of 1.76.
• Evidence for pharmacologic interventions is limited and of very low confidence.
• Long-term outcome data beyond 1 year are not available.

Guideline-Based Recommendations

Diagnosis

• Seek historical and semiological information from patients and witnesses.
• Obtain video-EEG of typical seizure-like episodes where feasible.

Management

• Evaluate for co-occurring psychiatric disorders and epilepsy.
• Counsel patients on the benefits and risks of psychological interventions.

Monitoring & Follow-up

• Involve family and caregivers in the psychological treatment.

Risks

• Do not prescribe benzodiazepines or antiseizure medications without co-occurring epilepsy.
• Counsel patients on the risks and lack of evidence for these medications.

Patient & Prescribing Data

Patients diagnosed with functional seizures.

Psychological interventions are preferred over pharmacologic treatments.

Clinical Best Practices

• Provide a specific diagnostic label and rationale.
• Engage in shared decision-making regarding treatment plans.
• Ensure continuity of care for patients.

References

• Neurology