Functional Nonepileptic Seizures: Diagnosis, Comorbidity, Pathophysiology, and Management

Purpose of Review The diagnosis and treatment of functional nonepileptic seizures are challenging, in part related to a lack of familiarity with the diagnosis, clinician discomfort with delivering the diagnosis, and a need for more effective and multidisciplinary treatment interventions. The purpose of this report is to describe relevant risk factors, diagnostic workup, comorbidity, proposed pathophysiological mechanisms, and management strategies. Recent Findings Advances in neuroimaging are shedding light on structural and functional differences in the brains of those living with functional nonepileptic seizures. Psychotherapy is the mainstay of treatment, but neuromodulation, e.g. repetitive transcranial magnetic stimulation (rTMS), may hold promise. Summary Functional nonepileptic seizures are a subtype of functional neurological disorder, formerly known as conversion disorder. An accurate diagnosis is often delayed, and the disorder is associated with higher rates of psychiatric complications, disability, and diminished quality of life. The underlying causes most likely include neural connectivity, psychological, and social factors. While treatment can be effective, access to expert care and nonadherence present barriers.