Neurology Learning NetworkAAN Issues Evidence-Based Guideline for Management of Functional Seizures

AAN released first evidence-based guideline for functional seizures showing psychological therapy works while most patients receive inappropriate antiseizure medications. Systematic review of 12 studies found psych interventions nearly double seizure freedom rates (RR 1.87) while benzos and ASMs show no benefit without co-occurring epilepsy.

⚖️ PROFESSIONAL IMPACT

• Psychological interventions increase seizure freedom probability nearly 2-fold compared to standard care, challenging current treatment patterns favoring medication
• Guideline explicitly recommends against benzodiazepines and ASMs for functional seizures without epilepsy—no evidence of benefit for seizure reduction or quality of life
• Video-EEG or smartphone video reviewed by neurologist improves diagnostic accuracy, reducing years of misdiagnosis and inappropriate treatment exposure
• Most patients currently receive no targeted evidence-based treatment despite available psychological therapies (CBT, neurobehavioral therapy, ReACT) showing measurable benefit

🎯 ACTION ITEMS

• Refer functional seizure patients to specialized psychological therapy (CBT, neurobehavioral therapy, or ReACT) as first-line treatment
• Discontinue benzodiazepines and antiseizure medications in functional seizure patients without confirmed co-occurring epilepsy
• Request smartphone videos from patients/family when video-EEG unavailable to improve diagnostic confidence
• Train staff on non-stigmatizing communication emphasizing functional seizures as genuine neurological condition amenable to treatment

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