Testing the ‘seizure scaffold’: What can experimental simulation tell us about functional seizures?

It has been suggested for over 100 years that patterns of neurological symptoms and signs in functional neurological disorders may be shaped at a neural level by underlying ideas or preconceptions how neurological symptoms present. This study used experimental simulation to probe ideas about seizure...

Full description

Saved in:
Bibliographic Details
Published in:Epilepsy & behavior 2020-12, Vol.113, p.107518-107518, Article 107518
Main Authors: Tiefenbach, Jakov, Cox, Emily R., Paterson, Mhairi, Iannoukos, Denis, Scott, Shona, Hoeritzauer, Ingrid, Carson, Alan, McWhirter, Laura, Stone, Jon
Format: Article
Language:English
Subjects:
Dissociative seizures
Electroencephalography
Epilepsy
Functional neurological disorder
Functional seizures
Humans
Mental Disorders
Seizures
Simulated seizures
Syncope
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:It has been suggested for over 100 years that patterns of neurological symptoms and signs in functional neurological disorders may be shaped at a neural level by underlying ideas or preconceptions how neurological symptoms present. This study used experimental simulation to probe ideas about seizures in healthy volunteers, with a view to compare with features commonly observed in functional and epileptic seizure disorders. Sixty healthy volunteers were instructed to simulate an epileptic seizure. The episodes were video-recorded and assessed by three qualified markers for the presence of clinical features commonly observed in functional seizures (FS), epileptic seizures, and syncope. Simulated seizures were hyperkinetic (83%), hypokinetic (7%), or staring (10%). Fifty-two percent had their eyes open and 45% eyes closed. Tremor was observed in 70%, while clonic jerking was only present in 17%. The majority of volunteers maintained a normal or floppy body posture. Head shaking side-to-side was observed in 38%, while guttural cries, stertorous breathing, tearfulness, and hyperventilation were absent in all volunteers. Our results suggest that simulated seizures not only resemble FS more closely than epileptic seizures but also show some important differences. Subjective seizure experiences in people with FS, not captured by this experimental simulation, remain a core determinant of semiology.
ISSN:1525-5050
1525-5069
DOI:10.1016/j.yebeh.2020.107518