SEIZURES AND TICS

Managing Functional Neurological Disorder (FND) with Seizure-like Episodes

Seizure-like episodes are a common presentation in Functional Neurological Disorder (FND), often referred to as Functional Seizures or Psychogenic Non-Epileptic Seizures (PNES). These are real, involuntary events caused by functional disruptions in the brain, not electrical abnormalities as in epilepsy.

Types of Functional Seizures in FND

1. Dissociative Seizures (Most Common)

• May involve unresponsiveness, staring, or collapsing

• Often prolonged compared to epileptic seizures

• Can include limb shaking, vocal sounds, or body stiffening

• Eyes typically closed; person may retain awareness during part of event

2. Functional Tonic-Clonic-Like Seizures

• Resemble epileptic convulsions (stiffening + jerking)

• Often last longer, lack postictal confusion

• Breathing usually remains steady; may involve crying or vocalizing

3. Myoclonic Movements

• Sudden, brief jerks or twitches in limbs or face

• May be repetitive or stimulus-triggered (e.g., sound, touch)

• Often not associated with loss of consciousness

4. Functional Absence-Like (Petit Mal-Type)

• Staring spells, "zoning out," or brief unresponsiveness

• May be confused with daydreaming or dissociation

• No postictal phase

Triggers and Warning Signs

• Stress, trauma recall, anxiety, sensory overload

• Fatigue, flashing lights, overstimulation

• Feelings of unreality or emotional overwhelm

• Aura-like sensations (tingling, visual changes, nausea)

Management Strategies

1. Accurate Diagnosis

• Video EEG to rule out epileptic seizures

• History, duration, eye status, and response to stimuli are key

• Education is crucial: explain the seizures are real, treatable, and non-epileptic

2. Seizure Safety Protocols

• Place in a safe space away from hazards

• Cushion head if convulsive movements occur

• Turn onto side if needed for airway safety

• DO NOT restrain, shake, or shout

• Monitor for duration and return of awareness

3. Recovery and Grounding

• Allow time for reorientation

• Reassure calmly

• Offer grounding tools: water, familiar objects, low stimulation

4. Psychological & Trauma-Informed Therapy

• CBT or ACT to manage stress and avoidance patterns

• EMDR or trauma therapy when trauma is present

• Psychoeducation about body’s stress response and dissociation

5. Self-Management Tools

• Track triggers and early warning signs (journals, apps)

• Use grounding techniques during auras

• Breathing or tapping techniques to reduce escalation

• Crisis plan: who to contact, what to do

6. Medication Considerations

• Anti-epileptic drugs do NOT treat functional seizures

• SSRIs/SNRIs may help if anxiety or depression is a trigger

• Avoid overmedicalization once diagnosis is confirmed

Communication and Speech Considerations

• Post-seizure mutism or word-finding difficulty is common

• Allow time, use communication cards or text tools

• Validate experience—do not minimize or rush

When to Escalate

• First-time seizure-like event (medical evaluation needed)

• Seizure > 10 minutes with no improvement

• Repetitive back-to-back seizures

• Loss of breathing or risk of injury

• No recovery after typical duration for the person

Care Team Involvement

• Neurologist: Rule out epilepsy, confirm diagnosis

• Psychologist/Therapist: Core treatment for underlying causes

• Occupational Therapist: Routine and pacing strategies

• Speech Therapist: Post-event communication support

• Primary Care Provider: Medication, general health

Functional seizures in FND are very real, frightening, and treatable. With proper care, safety, and psychological support, patients can learn to manage and reduce episodes over time.