Tailored provocation in functional seizures, a pilot study.

OBJECTIVE

To investigate whether Tailored Provocation (TP) can result in habitual seizures during electroencephalogram (EEG) recording in patients with a probable diagnosis of functional seizures (FS) and if future research is feasible.

BACKGROUND

The integrative model for FS suggests that seizures can be triggered by internal and external stimuli like a conditioned reflex. Using these individual stimuli as TP to provoke habitual seizures may improve diagnostic yield during EEG recording.

METHODS

We identified individual TP and evaluated practical applicability. If possible we applied TP and analyzed the occurrence of habitual seizures and the perceived burden on participants. TP was conducted during EEG recording, in addition to standard photic stimulation and hyperventilation.

RESULTS

We included 15 of 38 patients (39 %). Of these patients, 9 (60 %) experienced a habitual seizure after TP, confirming the diagnosis of FS. Epilepsy was diagnosed in 2 patients (13.3 %). All participants supported the goal of TP, and none found TP to be very or excessively burdensome.

CONCLUSION

TP seems promising to increase diagnostic yield during EEG-diagnostics. Further research is needed to confirm this in larger cohorts. Still, delineating whether FS provocation is directly linked to TP or to related factors, like the effect of verbal suggestion or repeated provocation, remains challenging.