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Just published December 10th, 2025, the American Academy of Neurology’s newest guideline on Management of Functional Seizures

This guideline provides evidence-based recommendations for clinicians, patients, and other stakeholders on the management of functional seizures.

There are 6 total recommendations with multiple statements for each, so in today’s video we’ll just be going over the first 2 statements for each recommendation. To view the full guidelines, make sure to check it out on guidelinecentral.com. Let’s get started. 

Recommendation 1 states,

  • Clinicians should include functional seizures in the differential diagnosis and in the initial workup of patients presenting with seizure-like or syncope-like episodes to make a prompt and accurate diagnosis. 
  • When evaluating patients with seizure-like or syncope-like episodes, clinicians should seek historical and semiological information from both patients and witnesses when available to support a prompt and accurate diagnosis.

On to recommendation 2,

  • Clinicians should evaluate patients diagnosed with functional seizures for co-occurring psychiatric disorders to facilitate treatment of both co-occurring disorders and functional seizures. 
  • Clinicians should offer patients diagnosed with functional seizures and active co-occurring psychiatric disorders, who do not already receive mental health care, a referral to a mental health specialist for appropriate evidence-based treatment of their co-occurring psychiatric disorders.

Recommendation 3 says,

  • Clinicians should evaluate patients diagnosed with functional seizures for co-occurring epilepsy to deliver appropriate treatment. 
  • Clinicians should use history, semiology, and where feasible, VEEG to help patients with co-occurring functional and epileptic seizures to accurately identify and distinguish different seizure types to deliver appropriate treatment. 

Recommendation 4 says,

  • Neurologists and mental health clinicians should collaborate in the assessment and treatment of functional seizures to facilitate evidence-based treatment. 
  • Clinicians should adhere to universal standards of care for patients, including speaking respectfully, refraining from unnecessary harm, and avoiding stigmatizing behavior to prevent harm to patients. 

Recommendation 5 states,

  • When psychological interventions for the treatment of functional seizures are indicated and accessible, clinicians should counsel patients regarding the potential benefits and risks of such interventions to facilitate shared decision making. 
  • When caring for patients with functional seizures, clinicians whose scope of practice does not include counseling patients regarding the possible benefits and demands of psychological interventions should refer patients to a clinician knowledgeable about modalities of psychological treatment to facilitate evidence-based treatment. 

And last, recommendation 6 says,

  • Clinicians should counsel patients with functional seizures without co-occurring epilepsy or another indication for benzodiazepines regarding the potential risks and lack of evidence of benefit for functional seizures associated with benzodiazepines. 
  • Clinicians should not prescribe benzodiazepines for acute abortive treatment in patients with functional seizures without co-occurring epilepsy, anxiety disorders, or another indication, to reduce the risk of adverse effects. 

And there you have it. Make sure to check out the guideline from The American Academy of Neurology and other related clinical decision support tools at guidelinecentral.com.

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