EXPLORING THE THERAPEUTIC POTENTIAL OF NEUROPSYCHOPHARMACOTHERAPY AGENTS IN MANAGING FUNCTIONAL/DISSOCIATIVE SEIZURES: A COMPREHENSIVE CASE STUDY
Authors: Nugraheni *Putri , Irawan Attaufiq , Dohong Almerveldy Azaria , Putri Adelina Dwi , Faiq Ahmad Rafi 
Published: February 2025

Abstract

Background
Functional/dissociative seizures (FDS) are periods of abnormal behavior and experience, typically involving impairment of consciousness and involuntary movements (Asadi-Pooya et al., 2019). Most cases manifest between the age of 15 and 35 years and they are 4 to 5 times more commonly affecting women. People with FDS are more likely to report previous traumatic experiences than those with epilepsy or general population (Hingray et al., 2022). Clinicians are often underdiagnosing, undertreating, and confusing FDS with epilepsy as they resemble epileptic seizures. Several studies have tried to explore neurobiology of FDS and found abnormalities in several regions of the brain, including prefrontal cortex, anterior cingulate gyrus, insula, hippocampus and amygdala, based on imaginary findings using DTI, PET - Scan and fMRI (Gargiulo et al., 2022). Up until today, we have not found a specific guideline on FDS diagnosis and management.
Aims and Objectives This case report discusses comprehensive studies on pharmacological treatment of FDS.
Method We present a case study of a 27- year-old woman who was admitted due to FDS.

Case Presentation
In March 2023, Ms. F was admitted to ER after suddenly dropping to the floor unconscious, followed by a generalized amnesia. Two months later, she was re-admitted due to similar event, followed by 5 episodes of tonic clonic seizure, each lasting for 5 minutes. In both occasions, vital signs, neurological examinations, ECG, EEG, brain CT scan without contrast and laboratory findings were within normal limits. She was given citicoline, flunarizine, paracetamol and betahistine. Neurologist made a diagnosis of suspected atonic seizure in first admission and generalized tonic clonic seizure in second admission, but refrained from giving antiepileptic drugs (AEDs) due to atypical symptoms. Neurologist made a consultation to Psychiatrist who found that Ms. F also changed personality after every seizure episode. In total, she had four different personalities who emerged when triggered by stressors. Ms. F routinely visited a psychiatrist in another hospital for recurrent depression and dissociative disorder for the last 3 years, but never had a seizure before. She has been receiving CBT, aripiprazole, fluoxetine and clobazam. Psychiatrist gave her education about FDS, amnesia dissociation, identity dissociation and their relation to stressors. Patient’ s routine psychiatric medications were resumed. In both hospitalization periods, amnesia and identity dissociation ceased on day 3.
Discussion and Conclusion: The treatment of FDS requires a multifaceted approach (LaFrance et al., 2014). Cognitive behavioral therapy-informed psychotherapy (CBT-ip) has been shown to significantly reduce seizure frequency, particularly when combined with pharmacological treatments, while pharmacological treatment alone is less effective. Further research supports the efficacy of CBT- ip, with or without medication, in reducing seizure episodes (LaFrance et al., 2014; Baird, et al., 2017).
Studies also show benefits from immediate withdrawal of AEDs (Oto et al., 2010). Effective FDS management involves accurate diagnosis, comprehensive psychoeducation, and addressing comorbid psychiatric conditions; making the role of neuropsychiatrists crucial. Treatment success extends beyond seizure reduction, encompassing improvements in functional capacity, mental health, and healthcare utilization (Beghi, 2019).