Functional, nonepileptic seizures show structural abnormalities in brain scans, study shows

Oct. 24, 2022
For a long time, nonepileptic seizures were not believed to involve structural changes in the brain.

There are just over 3 million Americans with epilepsy who experience seizures due to abnormal electrical activity in the brain. 

A smaller group of people also have seizures not caused by epilepsy – known by many names, including functional seizures, psychogenic seizures, nonepileptic seizures, or even the pejorative term pseudoseizures. Scientists have long understood these as the body’s response to mental stressors, like anxiety and post-traumatic stress disorder. But a new study finds that functional seizures are associated with structural changes in the brain that can be seen using MRI. 

The team of researchers led by Michigan Medicine analyzed more than 650 clinical-grade MRIs, comparing images from patients with functional seizures to those who did not experience seizures and could have other mental health conditions, such as depression and anxiety. 

Results published in Epilepsy & Behavior reveal that patients with functional seizures had thinning in the superior temporal cortex, which affects a person’s cognitive awareness and control of one’s actions, and thickness of the left occipital cortex, responsible for the processing of visual and other sensory information. These changes were not present in people who had depression, anxiety and obsessive compulsive disorder (OCD). 

One of the challenges in treating functional seizures is identifying them early enough. Most patients with functional seizures are treated for epilepsy for an average of nine years before being correctly diagnosed. 

Psychotherapy is used as a treatment for functional seizures to address the underlying psychological stressors that are overflowing and leading to symptoms. 

While epilepsy has the distinct marker of electrical abnormality, discerning between the condition and a functional seizure is not simple. Clinicians diagnose epilepsy based on the number and type of seizures someone experiences, along with diagnostic testing. If seizures are epileptic, not acting quickly could cause permanent brain damage or death. 

After hearing about or observing a seizure, providers can take an electroencephalogram, or EEG, which picks up electrical signals in the brain. However, about half of people with known focal epilepsy have EEGs that are read as normal. 

U of M Health release