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Symposia

Adult- Health Psychology / Behavioral Medicine

From Uncertainty to Understanding—Prognoses, Progress, and Multi-Morbidity in Functional Seizures to Advance Clinical Science and Compassionate, Patient-Centered Care

1 - (SYM 13) Real-world Change in Seizure Frequency During and After Neurobehavioral Therapy for Functional Seizures

Friday, November 21, 2025
12:18 PM - 12:37 PM CST
Location: Bolden 2, Level 2
Keywords: Comorbidity, Evidence-Based Practice, Underserved Populations
Recommended Readings: Asadi-Pooya, A. A. (2023). Incidence and prevalence of psychogenic nonepileptic seizures (functional seizures): A systematic review and an analytical study. International Journal of Neuroscience, 133(6), 598–603. https://doi.org/10.1080/00207454.2021.1942870,   Goldstein, L. H., Robinson, E. J., Mellers, J. D. C., Stone, J., Carson, A., Reuber, M., Medford, N., McCrone, P., Murray, J., Richardson, M. P., Pilecka, I., Eastwood, C., Moore, M., Mosweu, I., Perdue, I., Landau, S., Chalder, T., Abe, A.-M., Adab, N., … Yogarajah, M. (2020). Cognitive behavioural therapy for adults with dissociative seizures (CODES): A pragmatic, multicentre, randomised controlled trial. The Lancet Psychiatry, 7(6), 491–505. https://doi.org/10.1016/S2215-0366(20)30128-0,   Lopez, M. R., & LaFrance, W. C. (2022). Treatment of psychogenic nonepileptic seizures. Current Neurology and Neuroscience Reports, 22(8), 467-474. https://doi.org/10.1007/s11910-022-01209-3,   Robson, C., & Lian, O. S. (2017). “Blaming, shaming, humiliation”: Stigmatising medical interactions among people with non-epileptic seizures. Wellcome Open Research, 2, 55. https://doi.org/10.12688/wellcomeopenres.12133.2,  
Abstract Body

Otherwise known as psychogenic nonepileptic seizures (PNES), functional seizures

(FS) are associated with substantial decreases in quality of life, increases in healthcare

utilization, and increased mortality rate. While there are some trials demonstrating the impact of neurobehavioral treatment, there is limited real-world evidence. To begin to gauge the impact of a holistic multidisciplinary FS treatment clinic, we evaluated the changes in seizure frequency

from diagnosis through treatment and follow-up.


We evaluated 179 patients referred to the multidisciplinary FS clinic at one

Comprehensive Epilepsy Center. We performed retrospective chart review to track seizure

frequency at diagnosis, evaluation for therapy, throughout the course of therapy, and up to 12-

months after onset of therapy or diagnosis, both for patients who underwent therapy and those

who did not. We evaluated the changes in seizure frequency, relative to diagnosis, throughout

treatment and 12-month follow-up.


At the post-diagnosis evaluation visit, which was before starting therapy, seizure

frequency compared to at diagnosis was variable, with 50% having more seizures and 50%

having less frequent seizures, including 16% seizure freedom. At the last therapy visit

completed, the 50% of patients had half as many seizures, 30% of patients were seizure free,

and, conversely, 35% had a higher seizure frequency than when they were diagnosed. For 42 of

these patients with 12-month follow up, the median reduction in seizure frequency was 80%,

including 39% of patients were seizure free and, conversely, 25% had a higher seizure

frequency than when they were diagnosed.


Diagnosis without treatment was not consistently associated with a reduction in

seizure frequency. Most patients who underwent treatment had a substantial reduction in

seizure frequency. However, 12-months after diagnosis, only 39% of patients were seizure free.