Qualitative analysis of written accounts of functional/dissociative seizures.

Functional/dissociative seizures (FDS) involve a complex mix of symptoms spanning physical, emotional, autonomic, and cognitive domains, according to personal accounts from 75 authors with FDS. The most common symptom domain was consciousness, mentioned by 63 of 75 authors, particularly impaired awareness, self-control, and disconnection. Motor symptoms appeared in 58 narratives, including excessive, reduced, or mixed movements. Sensations such as pain were reported by 13 authors. Arousal symptoms, especially hyperarousal, appeared in 20 accounts. Emotional symptoms, particularly anxiety, were noted by 22 authors. Cognitive issues like foggy thinking and memory deficits were described in 14 writings. These detailed descriptions may aid earlier diagnosis.

Study at a glance

Abstract

Subjective experiences of functional/dissociative seizures (FDS) are important for diagnosis and treatment formulation. This study aims to improve the symptomatological understanding of these seizures by analysing written narratives provided by authors with personal FDS experience. Descriptions of FDS were extracted from contributions to the book "In Our Words: Personal Accounts of Living with Non-Epileptic Seizures". Immediately preictal, ictal or postictal seizure symptoms were identified and subjected to summative content analysis. Themes and subthemes were derived inductively and deductively. Of 93 authors with FDS who submitted contributions to the book, 75 mentioned seizure symptoms. In most narratives, FDS involved a complex, multidimensional symptomatology. Six superordinate symptom domains emerged: 'consciousness', 'movements', 'sensations', 'arousal', 'emotions', and 'cognition'. Within the superordinate theme of 'consciousness' (63/75 writings), 'awareness' was most frequently topicalised, followed by impairment of 'self-control/ responsiveness' and 'disconnection'. The second most prominent superordinate theme of motor symptoms (58/75 authors) included 'positive' (excessive activity), 'negative' (reduced motor activity) and 'mixed' symptoms. Accounts of sensations similarly included 'hypersensitivity', 'hyposensitivity' and 'mixed' symptoms. 'Pain' was another prominent sensory subtheme (13/75 narratives). The 'arousal' theme (20/75 accounts) captured 'hyper-' more often than 'hypoarousal'. In the superordinate theme 'emotions' (22/75 authors) 'anxiety' symptoms were particularly prominent. The superordinate 'cognition' theme (14/45 writings) mainly captured 'foggy thinking' and 'memory deficits'. In the words of individuals with personal experience, FDS emerge as complex and heterogeneous phenomena spanning physical, emotional, autonomic and cognitive domains. The characterization of FDS symptomatology should help with earlier diagnoses.