The AAN Publishes New Guidelines on Diagnosing and Managing Functional Seizures

The American Academy of Neurology (AAN) has published new clinical practice guidelines in Neurology, providing evidence-based recommendations for the diagnosis and management of functional seizures, or episodes that resemble epilepsy but with different, nonepileptic causes. The recommendations identify psychological interventions as possibly effective for reducing seizure frequency, improving quality of life, and decreasing anxiety. The published guidelines also discourage the use of antiseizure medications (ASMs) in the absence of co-occurring epilepsy. This is the first set of clinical practice guidelines published by the AAN that focus on a functional neurologic disorder, according to a statement released by the organization.

The guidelines, which were endorsed by the American Epilepsy Society, were developed through a review of available published evidence on functional seizures. A multidisciplinary panel convened by the Guidelines Subcommittee of the AAN performed a systematic review of 12 class II–III studies using a modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. A modified Delphi process was used to formulate the practice recommendations. The recommendations are intended to assist neurologists and other clinicians in diagnosing and managing functional seizures in their patients to reduce the frequency and impact of functional seizures and improve health-related quality of life and psychosocial functioning.

Key recommendations include the following:

• Psychological interventions, such as functional seizure–specific cognitive behavioral therapy, neurobehavioral therapy, paradoxical therapy, and motivational interviewing with psychotherapy, are possibly effective and generally well tolerated.
• Clinicians should be clear, empathetic, and supportive when delivering diagnoses to patients, with family members and care partners present when appropriate.
• Clinicians should evaluate for co-occurring epilepsy and psychiatric disorders and obtain detailed seizure descriptions from the patient and observers, including video if available.
• Antiseizure medications, including benzodiazepines, should not be prescribed solely for functional seizures; these medications should be tapered unless another indication exists.
• Improved diagnostic tools, including AI and wearable devices, may support future efforts in identifying functional seizures.
• Neurologists and mental health clinicians should collaborate in the assessment and treatment of functional seizures and adhere to universal standards of care that avoid stigmatizing behavior or unnecessary harm.
• Clinicians should provide a specific diagnostic label and rationale, engage in shared decision-making about treatment, and ensure continuity of care, including counseling patients and caregivers on seizure action plans, driving, and the impact on work and social functioning.

Source: Tolchin B, Goldstein LH, Reuber M, et al. Management of functional seizures practice guideline executive summary. Neurology. 2026;106(1):e214466. doi:10.1212/WNL.0000000000214466.