Functional seizures: The patient’s perspective of a diagnostic and treatment odyssey, 2022, Andrini et al

Highlights

• Functional seizures remains a complex neuropsychiatric condition to identify and treat.
• Practitioners must address management of physical symptoms and underlying causes.
• Management strategies can fail if their reasoning is not properly communicated.
• Better outcomes may result where treatment rationale is emphasized from outset.

Abstract

Functional seizures can be challenging to properly diagnose, often leading to delays in treatment. The etiology of functional seizures is multifactorial, with psychological factors identified in many, but not all cases. Misdiagnosis may occur due to clinical features mimicking other medical conditions. Once a correct diagnosis is reached, delivery of definitive, evidence-based treatment may be challenging due to limited availability of specialized resources. Research shows psychological education and cognitive behavioral therapy (CBT) have the greatest efficacy. However, individual differences, including acceptance of the diagnosis, therapeutic alliance, duration of symptoms, comorbidities, and access to care may influence outcomes. There is a critical need for reports that can help identify barriers to effective diagnosis and treatment.

We present the diagnosis and treatment of a woman who visited the emergency room after an attack of predominant left-sided paralysis, speech dysfunction and altered awareness. Following multiple daily episodes and visits to multiple medical practitioners, testing led to a diagnosis of functional seizures. While the patient was recommended to undergo a variety of therapeutic interventions, including CBT, she ultimately terminated treatment. In a subsequent interview, the patient revealed her personal experience with perceived limitations of acute management strategies. We explore the complexities of diagnosing and treating individuals with functional seizures.

Open access, https://www.sciencedirect.com/science/article/pii/S2589986421000836

 

Trying to wrap my head around the term "functional seizures" :') .

 

I'm trying to wrap my head around the idea of a "clinical feature" mimicking anything - let alone "other medical conditions".

 

Is this one of those "CBT" sessions where the patient has to confess to a distressing life event which is seized on as the reason for their physical symptoms?

(I went through something similar in a IAPT supposedly "CBT" setting where the therapist picked through my childhood and adolescence (before ME) trying to find something that would explain to them why I ended up sick. I was then expected to agree to this as being the cause.

The Therapist told me that all ME cases and all immune related diseases (including autoimmune) were caused by distressing previous experiences. hence the interest in families, current relationships, work etc

There was, like this patient maybe?, a lack of interest in how a lack of medical care harmed me)

 

I don't blame this poor woman for terminating treatment. Apart from anything else, the patient appears to live in the USA. So she is paying for all this failed and useless treatment.

I wonder if they actually did much in the way of biological testing. I was rather shocked to see that they prescribed Haloperidol (an anti-psychotic used in the treatment of schizophrenia) in the very beginning because of a comment from the patient that it helped 23 years ago. In the patient's shoes I would have kept quiet about this.

This appears to me to be very, very lazy doctoring. I wonder what evidence there was that the diagnosis (if any) and treatment was correct 23 years ago. It sounds as if the doctors were just "winging it".

Just as an aside...

Various parts of my body used to lock up sometimes and any attempt at relaxing would fail within seconds, although I don't have the problem any more. As a result of experimentation (by me) I found out that my problem was magnesium deficiency. Cheap as chips and works very quickly if my muscles won't relax e.g. if I get cramp.

According to wikipedia (I know, I know - a dreadful reference), magnesium deficiency can cause epileptic seizures . Yet, if you read the link on epileptic seizures it doesn't mention magnesium deficiency as a cause. The problem with testing magnesium is that it is an extremely poor test and few people would ever show up as being deficient in a such a test.

There are various other electrolytes that can cause muscles to spasm if levels are wrong. I wonder what the effect would be on the head and brain.

 

I read this first as the mother having been bitten when the mother was 15, but when I re-read it I was convinced that the patient herself was bitten when the patient was 15. It's not clear. But we know two things: Someone was bitten, and someone was 15.

 

How old was the dog?

 

It all sounds to me like propaganda. That poor woman.

 

The only interesting question which arises from this paper is: "Do they run any critical thinking classes at Schmid College of Science and Technology, or, come to that at Stanford?"

EDIT perhaps I should expand on that.

How can they say that etiology is multifactorial when they don't know the causes? All they can claim are correlations. Is that what they mean by etiology? Presumably the multifactorial features are biopsychosocial. But that, potentially, includes everything. What useful claims are made?

At least when Wessely claimed that etiology was not important, it was a meaningful statement - even if wrong.