Functional (psychogenic non-epileptic/dissociative) seizures: why and how?

Abstract

Functional seizures (FS) known also as psychogenic non-epileptic seizures or dissociative seizures, present with ictal semiological manifestations, along with various comorbid neurological and psychological disorders. Terminology inconsistencies and discrepancies in nomenclatures of FS may reflect limitations in understanding the neuropsychiatric intricacies of this disorder. Psychological and neurobiological processes of FS are incompletely understood. Nevertheless, important advances have been made on underlying neuropsychopathophysiological mechanisms of FS. These advances provide valuable information about the underlying mechanisms of mind–body interactions. From this perspective, this narrative review summarises recent studies about aetiopathogenesis of FS at two levels: possible risk factors (why) and different aetiopathogenic models of FS (how). We divided possible risk factors for FS into three categories, namely neurobiological, psychological and cognitive risk factors. We also presented different models of FS based on psychological and neuroanatomical understanding, multilevel models and integrative understanding of FS. This work should help professionals to better understand current views on the multifactorial mechanisms involved in the development of FS. Shedding light on the different FS profiles in terms of aetiopathogenesis will help guide how best to direct therapy, based on these different underlying mechanisms.

Hypermobility in patients with functional seizures: Toward a pathobiological understanding of complex conditions

“…Nevertheless, FS lie at the diagnostic interface of neurology and psychiatry, and research should therefore encompass a holistic, cognitive neuroscientific approach to these embodied symptoms. Indeed, this approach is reflected in recent, expert led reviews of the potential mechanisms underlying FS [5]. However, one factor that has been neglected in these reviews is joint hypermobility, which has been shown to be associated with several neuropsychiatric disorders [6,7].…”

Heterogeneity of patients with functional/dissociative seizures: Three multidimensional profiles

“…7,14 Consequently, several studies have explored how these risk factors interact in the development of FDS as predisposing, precipitating, or perpetuating factors. 3,8,15 Unfortunately, the multifactorial etiology and complex interactions between different factors make it difficult to devise a unitary etiopathological model or to devise treatment manuals. 3,8,15 The diagnosis of FDS was long based on the exclusion of epilepsy.…”

“…3,8,15 Unfortunately, the multifactorial etiology and complex interactions between different factors make it difficult to devise a unitary etiopathological model or to devise treatment manuals. 3,8,15 The diagnosis of FDS was long based on the exclusion of epilepsy. Recent texts have emphasized the importance of "positive" diagnostic criteria, emphasizing what characterizes FDS disorders themselves rather than what these disorders lack in comparison to epilepsy.…”

“…7 Studies have identified multiple psychiatric, experiential, somatic, cognitive, and medical risk factors for FDS. 7,8 For instance, psychiatric comorbidity is found in nearly 70% of patients suffering from FDS, 3,9 and strong associations between FDS and somatoform disorder, 10 dissociative disorder, 11 posttraumatic stress disorder (PTSD), 12 depression, [11][12][13] anxiety disorder, 12,13 and personality disorder 11,12 have been described. People with FDS are more likely to report previous traumatic experiences than those with epilepsy or general population controls.…”

“… 7 , 14 Consequently, several studies have explored how these risk factors interact in the development of FDS as predisposing, precipitating, or perpetuating factors. 3 , 8 , 15 Unfortunately, the multifactorial etiology and complex interactions between different factors make it difficult to devise a unitary etiopathological model or to devise treatment manuals. 3 , 8 , 15 …”