Low-intervention care and duration of functional seizures: An exploratory study.

BACKGROUND

This exploratory study aims to explore whether a calm and safe environment, minimal external stimuli, and neutral behavior of bystanders and medical personnel may contribute to shorter functional seizure (FS) duration.

METHODS

This exploratory study included adults with documented-FS first diagnosed between December 2024 and August 2025. During seizures, only observation or minimal intervention to prevent harm was performed; no external stimuli (e.g., physical contact, manipulations, or forced head or body turning) were applied. Demographic and seizure-related data, healthcare utilization in the three months before diagnosis, and prospective 3-month follow-up data on seizure occurrence, duration, Emergency Medical Services (EMS) calls, and hospitalizations were collected.

RESULTS

Twenty-one patients with documented-FS were included. Hypermotor seizures were the most frequent subtype, observed in 12 patients (57%). Headache, often migraine, was reported as a common trigger for seizures by 67%. The most frequently reported actions prior EMU were turning the patient onto their side (to presumably protect the airway), which was done in 18 patients (85.7%), and massaging or shaking the limbs/body to "stimulate" the patient, reported in 17 patients (81%), splash water (11 patients, 52.4%), restraining the patient's movements occurred in 10 patients (47.6%).The median reported duration of a typical seizure was 20 min (IQR 11.5-40 min) decreased to approximately 7 min (IQR 4-10 min), and to 8 min (IQR 5-10 min) post-Epilepsy Monitoring Unit (EMU) period. Patients frequently contacted EMS in response to their seizures, with a median of 11 calls (IQR 8-24), EMS calls by relatives (familiar with the diagnosis) dropped to 0 (IQR 0-1).

CONCLUSION

In this exploratory study, FS recorded under calm, non-intervening conditions in the EMU were consistently shorter than patients' habitual seizures, and diagnosis combined with structured counseling was associated with marked reductions in emergency service use and hospitalizations.