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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

2 - (SYM 13) Latent Classes of Clinical Presentations Among Patients with Functional Seizures

Friday, November 21, 2025
12:37 PM - 12:56 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

Patients with functional seizures (a type of functional neurological disorder) often present with high rates of psychological comorbidity, medically unexplained symptoms, and high healthcare utilization. Prevalences for comorbid diagnoses with functional seizures likewise have been inconsistently reported across research studies, a phenomenon that has been attributed to the observed heterogeneity of PNES presentation. Characterizing patterns of comorbidity may thus not only help to derive hypotheses about the etiology of PNES but also may suggest potential clinical and institutional interventions.


In this investigation, medical records of patients referred for treatment of functional seizures within a Midwest multidisciplinary clinic (n = 588) between 2016-2023 were assigned 15 psychiatric and physical diagnoses aligned with prevalent comorbidities from the literature. Diagnoses were inferred from active problem list designations at the time of referral per patient, pulled from an automated registry linked to the electronic health record. Prevalence and theory guided which diagnoses were estimated as indicators, resulting in the following being retained: depression, anxiety, PTSD, epilepsy, headaches, chronic pain, digestive/intestinal disorders, asthma, and syncope. Latent class analysis was run on this data–a first in the literature for functional seizures. A two-class model was supported by all model fit indices, the results of which will be presented.


To further evaluate the practical implications of these analyses, the latent class conditional probabilities were then entered into a stepwise multilevel model to predict yearly healthcare utilization (i.e., emergency room visits, hospital admissions) following multidisciplinary clinic referral. Yearly and person-level variables were statistically controlled. Results from this and post hoc analyses demonstrated consistent contributions of class probabilities on increased healthcare utilization over time. This presentation will thus explore not only the extent of clinical heterogeneity among patients with functional seizures, but how those patterns may be associated with their health care.