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

“If we can figure out what brain changes make people have functional seizures, we can begin to look at how we can change that back,” said first author Wesley Kerr, M.D., Ph.D., a neurologist and epileptologist at University of Michigan Health.

“Right now, the treatment for functional seizures is cognitive behavioral-informed therapy, but this therapy isn’t effective for everyone. We hope to find new ways to target treatments to help patients have fewer seizures and better quality of life.”

Epilepsy misdiagnosis

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