Primum non nocere - Endotracheal Intubation for Prolonged Functional/ Dissociative Seizures in an Adolescent

Sep 28, 2026

Uploaded by dawugda

Functional/dissociative seizures (FDS) are a common manifestation of functional neurological disorder (FND) across adult and pediatric groups, contributing to substantial healthcare utilization and costs. FND and FDS are now treated as “rule-in” diagnoses using characteristic positive clinical findings rather than diagnoses of exclusion requiring extensive testing. Yet outcomes remain harmed by clinician unfamiliarity, including delays in recognition and management. The case describes an adolescent with FDS intubated and admitted for presumed convulsive status epilepticus, with subsequent resolution after interdisciplinary treatment. The work emphasizes training to enable early diagnosis, better outcomes, and reduced utilization.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

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Case Reports

Background

Case Presentation

Case Reports Primum non nocere: Endotracheal Intubation for Prolonged Functional/ Dissociative Seizures in an Adolescent Haley Moulton, MD1,2, Diane DerMarderosian, MD1, Ana Albuja Ponce, MD2,3 1 Department of Pediatrics, Hasbro Children's Hospital, 2 The Warren Alpert Medical School of Brown University, Brown University, 3 Department of Pediatrics and Neurology, Hasbro Children's Hospital Journal of Brown Hospital Medicine Vol. 5, Issue 1, 2025 Article Information Keywords: functional neurological disorder, functional seizure, psychogenic non-epileptic seizure, education, gender-nonbinary, gender diverse, conversion disorder, healthcare utilization, dissociative seizure [https://doi.org/10.56305/001c.151717](https://doi.org/10.56305/001c.151717) Submitted: July 28, 2025 EST Accepted: December 01, 2025 EST Published: January 01, 2026 EST Abstract Functional/dissociative seizures (FDS) are one of the most common manifestations of functional neurological disorder (FND) in both adult and pediatric populations. FND and FDS result in significant healthcare utilization and costs, often due to excessive medical interventions and workup. Previously regarded as a diagnosis of exclusion that required extensive testing to identify, FND and FDS are now more accurately understood as “rule-in” diagnoses, based on the presence of characteristic positive clinical findings. Early identification and evidence-based therapies can facilitate patient recovery. However, patient outcomes continue to be negatively affected by clinicians’ limited familiarity and comfort with this diagnosis. We describe the case of an adolescent with FDS who was intubated and admitted to the intensive care unit for presumed convulsive status epilepticus, and who has since had resolution ofFDS after treatment by an interdisciplinary team. Our goal is to highlight the need for increased training of healthcare personnel in the recognition and management of this important clinical entity to facilitate early diagnosis, improve clinical outcomes, and potentially decrease healthcare utilization. background Functional neurological disorder (FND) has been defined as “a neuropsychiatric disorder involving aberrant changes within and between neuron-glial networks as well as complex interactions between brain, mind, body, and context”.1 The pathophysiology ofFND is complex, involving hyperactivity of the limbic system and impaired sensory integration in terms of predictive coding and bottom-up processing of sensory inputs.2 Functional/dissociative seizures (FDS), also known as psychogenic nonepileptic seizures, are a common type of FND affecting adults and children.3 The annual incidence of FDS in children ranges between 7.4 and 18.3 per 100,000 .4‑6 However, this is likely an underestimation.7 As awareness of FDS increases, these numbers may continue to grow. In non-adult populations, the incidence ofFDS is highest among individuals between 11 and 19 years of age.5,6 Environmental factors can play a role in its development. For instance, increased incidence ofFND was reported in relation to the COVID-19 pandemic and its impact on mental health.8,9 Non-epileptic events account for approximately 15-30% of pediatric admissions to epilepsy monitoring units. Among non-epileptic events, FDS are the most common type, particularly in older children and adoles- cents.10, 11 FND and FDS are associated with significant healthcare utilization and costs.12 Approximately 20% of pediatric patients with FDS are readmitted or re-present to the emergency department within 30 days.13 Although there are limited data for pediatric populations, FDS in adults are associated with increased morbidity and mortality.14 Individuals with FDS can be misdiagnosed as having convulsive status epilepticus, leading tointubation and other iatrogenic complications.15‑18 Despite its clinical relevance and considerable healthcare utilization, clinicians often show limitations when

FAQs

What is the clinical significance of functional/dissociative seizures (FDS) in patients?

FDS are described as a common manifestation of functional neurological disorder (FND) and are associated with significant healthcare utilization and costs, often driven by excessive interventions and workup.

How are FND and FDS understood in modern practice according to the abstract?

They are framed as “rule-in” diagnoses based on characteristic positive clinical findings, rather than diagnoses of exclusion that require extensive testing.

What happened in the case described regarding intubation and the final outcome?

An adolescent with FDS was intubated and admitted to the ICU for presumed convulsive status epilepticus; FDS later resolved after interdisciplinary treatment.

Sep 28, 2026

Uploaded by dawugda