Effectiveness of brief semiological training in distinguishing functional/dissociative seizures from epileptic seizures

Objective: Functional/dissociative seizures are seizures that mimic epileptic seizures in their presentation and are often mistaken for them. Clinical recognition of these seizures presents a challenge and misdiagnosis can lead to inappropriate treatment, increasing the risk of complications. To address this, we conducted a study involving 45 young neurology residents from the Czech Republic and Slovakia who had no specialized training in epilepsy or functional neurological disorders. Our goal was to determine whether a brief training in selected semiological features of functional/dissociative seizures (FDS) would efficiently teach them to differentiate between FDS and epileptic seizures (ES) in a clinical setting.

Methods: A set of 10 clinical signs characteristic of FDS was selected based on Evidence-Based Practice for the Clinical Assessment of Psychogenic Nonepileptic Seizures (Baslet et al., 2021). Initially, participants identified epileptic seizures and FDS in 30 video recordings without any prior instruction. Subsequently, they received a 15-minute educational session focused on selected semiological features of FDS. Then the same 30 seizure videos were shown again to assess their recognition abilities. No EEG recordings were shown.

Results: Following this educational intervention, participants' accuracy in distinguishing FDS from ES significantly improved from 77% before training to 89% after training (p < 0.001). Importantly, recognition of epileptic seizures remained stable at 54% before and 53% after the training.

Conclusion: We demonstrated the effectiveness of a concise, targeted education on FDS semiological signs for clinical practice.