Assessing Psychiatric Comorbidities in Functional Seizures Under New AAN Guidelines: Benjamin Tolchin, MD, FAAN

WATCH TIME: 3 minutes

“Up to 90% of patients with functional neurologic disorders have co-occurring psychiatric conditions, and untreated depression or anxiety can make treatment of functional seizures much more difficult. Clear diagnostic clarity and psychiatric care are foundational to successful management.”

In late 2025, a group of investigators published new evidence-based guidelines for clinicians, patients, and other stakeholders in the management of functional seizures. Functional seizures, also labeled as dissociative seizures, are transient episodes of altered consciousness or involuntary movements resembling epileptic seizures or syncope but conceptualized to be driven by episodic dissociation or other cognitive-affective mechanisms. The review, based on 12 different studies, provided recommendations for diagnosis of functional seizures, assessment of psychiatric comorbidities and epilepsy, psychological interventions, and pharmacologic interventions.

Following the publication, NeurologyLive^® reached out to study author Benjamin Tolchin, MD, FAAN, director of the Center for Clinical Ethics at Yale New Haven Health, to break down various sections of the guidelines for our clinical audience. Tolchin, who also serves as an associate professor at the Yale School of Medicine, spoke specifically about psychiatric comorbidities, and the high frequency of psychiatric disorders, including mood disorders, anxiety disorder, and posttraumatic stress disorder, that occur in patients with functional seizures.

In the interview, Tolchin gave clinical perspectives on the high prevalence of co-occurring psychiatric disorders, the importance of early screening and formal psychiatric evaluation, and how untreated psychiatric illness can complicate psychotherapeutic treatment. He continued to refer back to the guidelines, emphasizing the need for thorough EEG evaluation to identify coexisting epilepsy in certain patients. Furthermore, he emphasized the need for clear differentiation between epileptic and functional events to guide both medication management and psychotherapy.

REFERENCE
1. Tolchin B, Goldstein LH, Reuber M, et al. Management of Functional Seizures Practice Guideline Executive Summary: Report of the AAN Guidelines Subcommittee. Neurology. 2026;106(1):e214466. doi:10.1212/WNL.0000000000214466