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New Guideline by AAN Aims to Improve Management of Functional Seizures

On December 10, 2025, the American Academy of Neurology (AAN) published an important new guideline that focuses on the management of functional seizures. These seizures, previously known as psychogenic nonepileptic seizures or non-epileptic attack disorder, can be mistaken for epileptic seizures, leaving many patients misdiagnosed and untreated.

With this guideline, the AAN addresses the challenges faced by neurologists, mental health clinicians, and other healthcare providers in diagnosing and managing these complex conditions. The new recommendation is not just a mere set of instructions, but rather a significant step towards understanding and mitigating the stigma surrounding functional seizures, a condition that has long been misunderstood.

Understanding Functional Seizures

Functional seizures may appear similar to epilepsy or fainting, but they stem from different origins and exhibit distinct features. These episodes can severely impact the quality of life for those affected, especially when misdiagnosed. This lack of understanding can lead to unnecessary prescriptions for antiseizure medications, which may not be beneficial for this category of seizures.

The guideline emphasizes that psychological interventions can potentially help individuals achieve freedom from functional seizures. These treatments aim to reduce the frequency of episodes, alleviate anxiety, and enhance the overall quality of life for patients.

Evidence-Based Treatment Approaches

The AAN conducted a comprehensive review of the evidence surrounding functional seizures. This review uncovered that specific psychological interventions—including cognitive behavioral therapies tailored to functional seizures, neuro-behavioral therapy, and motivational interviewing—are effective in treating this condition.

Benjamin Tolchin, MD, from Yale School of Medicine and one of the authors of the guideline, mentions, “There is a growing body of evidence demonstrating that potentially effective treatments are available for functional seizures once an accurate diagnosis is made.” Despite this, many patients still do not receive the necessary, targeted treatments, which perpetuates their symptoms and contributes to their disability.

Innovative Diagnostic Strategies

To ensure accurate diagnosis, the guidelines recommend clinicians engage in detailed discussions about seizure experiences. They should interview those who have witnessed the events and consider using modern technologies such as smartphone recordings and video electroencephalograms (EEGs). These advancements aim to differentiate functional seizures from epilepsy effectively and ensure appropriate treatment paths are established. 

Furthermore, it suggests health professionals should evaluate patients for any accompanying epilepsy or psychiatric disorders, providing them with a holistic understanding of their health.

Promoting Compassionate Care

The AAN emphasizes the importance of conveying diagnoses in a compassionate and supportive manner. Professionals are encouraged to include family members and caregivers in treatment discussions, especially when making decisions about therapeutic approaches. The guidance also states that when considering psychological therapies like cognitive behavioral therapy, healthcare providers should counsel patients thoroughly about the associated benefits and risks, assuring them that these interventions are generally safe and well tolerated.

Caution with Medication

A crucial component of this guideline is the caution against prescribing antiseizure medications such as benzodiazepines for functional seizures unless there is an underlying issue like co-occurring epilepsy. The risks associated with these medications, alongside a lack of proven benefits for functional seizures alone, necessitate a careful reevaluation of treatment strategies. Patients currently taking these medications without justification should be gradually tapered off them under medical supervision.

David L. Perez, MD, from Harvard Medical School, highlights an ongoing issue, stating, “Many people with functional seizures are initially misdiagnosed with epilepsy and treated with antiseizure medications before the correct diagnosis is made.” The new guideline serves as a tool for clinicians to accurately diagnose and manage functional seizures, ultimately improving patient outcomes and their overall brain health.

Looking to the Future

The guideline also acknowledges areas concerning functional seizures that lack conclusive evidence, calling for advancements in diagnostic techniques. Future considerations include exploring machine learning, artificial intelligence, and wearable devices as potential tools for more accurate diagnoses.

This pioneering guideline establishes a framework for improving the understanding and treatment of functional seizures. Discover more about brain health and the materials available through the AAN at Brain Life®, which aims to connect patients and caregivers with trusted information about brain health.

With over 40,000 members, the AAN remains at the forefront of neurological diseases and brain health, committed to advancing knowledge and care. For further insights, you can follow the AAN on various social media platforms such as Facebook, X, and Instagram.