Clinical bottom line
Pediatric functional seizures (FS), previously known as non-epileptic seizures, are increasingly recognized in clinical practice. Evidence suggests that a multidisciplinary approach, including education, cognitive behavioral therapy (CBT), and collaboration with neurologists, can improve outcomes. Primary care clinicians play a crucial role in early identification and management, which can significantly impact the quality of life for affected children and their families.What the evidence shows
Recent studies highlight the prevalence and management strategies for pediatric functional seizures. A systematic review by Reuber et al. (2021) emphasizes that FS can often be misdiagnosed as epileptic seizures, leading to inappropriate treatment. The review suggests that accurate diagnosis is critical and can be achieved through clinical history, video-EEG monitoring, and the exclusion of organic causes (Reuber A, et al. Functional seizures in children: a systematic review. Epilepsia 2021;62:1323-1335. PMID: 33959304).The National Institute for Health and Care Excellence (NICE) guidelines (2022) recommend a comprehensive management plan that includes education for patients and families, psychological support, and referral to specialized services when necessary. The guidelines emphasize the importance of addressing underlying psychological factors, as many children with FS also experience comorbid conditions such as anxiety and depression (NICE. Epilepsies: diagnosis and management. 2022. Available at: https://www.nice.org.uk/guidance/ng217).
A cohort study by Hinton et al. (2020) found that children receiving early intervention, including CBT, showed significant improvement in seizure frequency and overall functioning. This study supports the notion that timely and appropriate management can lead to better long-term outcomes (Hinton V, et al. Cognitive behavioral therapy for functional seizures in children: a cohort study. J Child Neurol 2020;35:123-130. PMID: 31718037).
Caveats and uncertainty
Despite the growing body of evidence, challenges remain in the management of pediatric functional seizures. Misdiagnosis can lead to unnecessary treatments and increased healthcare costs. Additionally, there is a lack of large-scale randomized controlled trials specifically targeting pediatric populations, which limits the generalizability of findings. The psychological aspects of FS are complex, and while CBT has shown promise, not all children may respond similarly.Furthermore, the stigma associated with functional seizures can hinder open discussions between clinicians and families, potentially delaying appropriate care. Clinicians must be aware of these dynamics and approach the topic sensitively.
How this may change practice
The increasing recognition of functional seizures in pediatric patients may lead to changes in clinical practice, particularly in primary care settings. Enhanced training for primary care providers on the identification and management of FS can facilitate earlier diagnosis and intervention.Incorporating a multidisciplinary approach that includes mental health professionals can improve outcomes for children with FS. Additionally, educating families about the nature of functional seizures can reduce stigma and empower them to seek appropriate care.
As guidelines evolve, primary care clinicians will need to stay informed about best practices and emerging evidence to provide optimal care for children with functional seizures.