A new guideline from the American Academy of Neurology (AAN) provides recommendations for treating functional seizures, aiming to assist neurologists, mental health professionals, and other clinicians in managing this condition. The guideline was published on December 10, 2025, in the journal Neurology and has been endorsed by the American Epilepsy Society.
Functional seizures—formerly referred to as psychogenic nonepileptic seizures or non-epileptic attack disorder—are episodes that resemble epilepsy or fainting but have distinct causes and features.
"There is a growing body of evidence demonstrating that potentially effective treatments are available for functional seizures once an accurate diagnosis is made," said Benjamin Tolchin, MD, MS, of the Yale School of Medicine and a Fellow of the AAN. "Nevertheless, most people with functional seizures do not receive targeted and evidence-based treatment, contributing to ongoing functional seizures and disability. Functional seizures have been a misunderstood condition, and this AAN guideline is a landmark effort to help overcome that stigma."
The development of the guideline followed an extensive review of existing research. The review found that psychological interventions can be helpful in increasing seizure freedom rates, reducing seizure frequency, lowering anxiety levels, and improving quality of life for patients with functional seizures. Some potentially beneficial approaches include cognitive behavioral therapies tailored to functional seizures, neuro-behavioral therapy, paradoxical therapy, and motivational interviewing combined with psychotherapy.
For diagnosis, the guideline advises clinicians to gather detailed accounts from patients about their episodes. It also suggests interviewing witnesses to the events and reviewing any available smartphone videos. In some cases, video electroencephalogram (EEG) testing may be warranted.
The document emphasizes evaluating patients diagnosed with functional seizures for possible co-occurring epilepsy or psychiatric conditions.
It recommends that clinicians communicate diagnoses clearly and empathetically. When appropriate, family members or other caregivers should be involved in discussions about treatment options.
When psychological interventions such as cognitive behavioral therapy are considered suitable, clinicians should discuss both benefits and risks with patients. According to the guideline, these interventions are generally safe and well tolerated.
The guideline also advises against prescribing antiseizure medications like benzodiazepines solely for functional seizures unless there is another medical reason or co-existing epilepsy present. Patients should be informed about potential risks associated with these medications when used alone for functional seizures; tapering off these drugs is recommended if no alternative indication exists.
"Many people with functional seizures are initially misdiagnosed with epilepsy and treated with antiseizure medications before the correct diagnosis is made," said David L. Perez, MD, MMSc, of Harvard Medical School and a Fellow of the AAN. "Neurologists and other clinicians can use this guideline to help diagnose and manage functional seizures, improving a person's quality of life and brain health overall."
The guideline notes several areas where evidence remains limited or lacking regarding functional seizures. It highlights a need for improved diagnostic techniques in future research efforts. Emerging technologies such as machine learning tools or wearable devices may play a role in enhancing diagnosis going forward.
