Functional Seizure

Authors

Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Examination

Yes/No Test

In the yes/no test, the patient is asked to say “yes” when they detect a stimulus and “no” when they do not detect a stimulus. A response of “no” immediately after a stimulus may indicate a nonorganic sensory loss. A response of “no” would suggest that a functional disorder is not present, as a truly anesthetic patient would not feel anything and therefore would not respond.

Forced choice test

In the Forced-Choice test, the patient is asked to distinguish between a sharp or dull stimulus, and an upward or downward movement of a toe or finger. A percentage of correct responses in a series of trials that is less than that observed by chance may indicate nonorganic sensory loss.

DDX

Signs of functional/dissociative seizures:

• Longer duration >90 seconds¹.
• Fluctuating course¹.
• Asynchronous movements¹.
• Side to side head or body movement¹.
• Closed eyes¹.
• Memory of the event¹.

Signs for epileptic seizures

• Post ictal confusion¹.
• Stertorous breathing¹.

References

1.

Bennett K, Diamond C, Hoeritzauer I, et al. A practical review of functional neurological disorder (FND) for the general physician. Clinical Medicine (London, England). 2021;21(1):28-36. doi:10.7861/clinmed.2020-0987