Functional non-epileptic attacks: essential information for psychiatrists

Abstract

Functional non-epileptic attacks (FNEA) are seizure-like events occurring in the absence of epilepsy. Having had many different names over the years including dissociative convulsions and pseudo-seizures, they now fall in the borderland between neurology and psychiatry, often not accepted by either specialty. However, there is evidence that there is a high rate of psychiatric comorbidity in these patients and therefore it is likely that psychiatrists will come across patients with FNEA and they should know the broad principles of assessment and management.We have provided a clinically based overview of the evidence regarding epidemiology, risk factors, clinical features, differentiation from epilepsy, prognosis, assessment and treatment.By the end of this article, readers should be able to understand the difference between epileptic seizures and FNEA, know how to manage acute FNEA, and understand the principles of neuropsychiatric assessment and management of these patients, based on knowledge of the evidence base.Consent statementInformed consent was obtained from the patient for publication of Box 1.Declaration of interestNone.

Clinical physiologists’ experiences of working with people with nonepileptic attack disorder: A qualitative study

“…Unlike epileptic seizures, non-epileptic attacks are not associated with abnormal electroencephalogram (EEG) changes, [4]. NEAD is classed as a medically unexplained symptom, and is believed to have a psychological origin, which manifests itself as somatic symptoms, [5]. NEAD poses a diagnostic challenge, with an average delay to diagnosis of 7.2 years, [6].…”

Using interictal seizure-free EEG data to recognise patients with epilepsy based on machine learning of brain functional connectivity

“…Another challenge of this study was to determine whether the "normal-looking" interictal EEG recordings of patients with non-epileptic attacks (the ictal EEG is normal during those episodes) occurring within the context of a psychogenic disorder, called non-epileptic attack disorder (NEAD) could be differentiated from equivalent recordings of patients with epilepsy. NEAD is a brain-related disorder which involves psychogenic non-epileptic seizures (Sheldon and Agrawal, 2019). According to Milán-Tomás et al (2018), about 20% to 40% of patients diagnosed with epilepsy also have NEAD rendering differentiation between the two conditions a challenging task for physicians.…”