Neurol. praxi. 2025;26(5):410-413 | DOI: 10.36290/neu.2025.025

Functional/dissociative seizure vs. epileptic seizure: how to distinguish them without EEG?

MUDr. Karin Revajová¹, MUDr. Ondřej Strýček, Ph.D.^{1, 2}, Ing. Michal Fusek, Ph.D.³, doc. MUDr. Pavlína Danhofer, Ph.D.⁴, MUDr. Patrícia Všianská⁴, doc. MUDr. Irena Doležalová, Ph.D.^{1, 2}

¹ Centrum pro epilepsie Brno, člen ERN-EpiCARE, 1. neurologická klinika Fakultní nemocnice u sv. Anny v Brně, Lékařská fakulta Masarykovy univerzity, Brno

² Středoevropský technologický institut (CEITEC), Masarykova univerzita, Brno

³ Ústav matematiky, Fakulta elektrotechniky a komunikačních technologií, Vysoké učení technické v Brně

⁴ Centrum pro epilepsie Brno, člen ERN-EpiCARE, Klinika dětské neurologie Fakultní nemocnice Brno, Lékařská fakulta Masarykovy univerzity, Brno

Functional/dissociative seizures (previously termed "psychogenic non-epileptic seizures") are seizures that mimic epileptic seizures and are frequently mistaken for them. They are often difficult to be recognized correctly and patients may receive improper treatment, which carries the risk of complications, as documented in a short case report included in this article. Video-EEG monitoring is the gold standard in diagnosing functional seizures. However, there are clinical situations in which it is important to be familiar with the clinical manifestations of functional seizures (such as in emergency medicine). The present article introduces how functional and epileptic seizures can be distinguished in the clinical practice. This is a set of ten clinical manifestations that are typical of functional seizures. The article also includes a study that was conducted at our institutions to demonstrate the usefulness of these features in the clinical practice.

Keywords: functional seizures, psychogenic non-epileptic seizures, epileptic seizures, semiology, video-EEG monitoring.

Received: March 19, 2025; Revised: March 19, 2025; Accepted: March 20, 2025; Prepublished online: March 20, 2025; Published: November 6, 2025  Show citation