Suggestive seizure induction techniques in paediatric functional/dissociative seizures: an extensive protocol

Functional/Dissociative Seizures (FDS) are complex neuropsychiatric events frequently misdiagnosed as epilepsy, particularly in children and adolescents. Accurate and timely diagnosis remains challenging, especially when standard or prolonged EEG recordings fail to capture typical episodes. This retrospective study evaluated the diagnostic utility and clinical correlates of a structured, non-invasive Suggestive Seizure Induction Technique (SSIT) protocol integrated within video-EEG. Twenty-five paediatric patients with suspected FDS (mean age = 14.7 years; onset = 13.1 years; 72 % females), all of whom had previously undergone inconclusive standard EEGs (and in 48 % of cases, also non-diagnostic prolonged vEEGs), were included. The SSIT protocol employed verbal suggestion, tuning fork stimulation, and soaked pad application over a mean duration of 33.8 min (SD = 11.3). A seizure response was observed in 52 % of the total sample, and 72 % showed nonspecific somatoform or dissociative reactions. Verbal suggestion and soaked pad techniques were the most effective, each eliciting seizure responses in 20 % of participants. All patients with a seizure SSIT response ultimately received a documented FDS diagnosis, while the review of the clinical documentation revealed that additional diagnoses were achieved during follow-up via prolonged or standard EEG. Psychological assessments revealed a significant association between seizure responses to verbal suggestion and dissociative symptoms, particularly "loss of control" (p < 0.05), while lower working memory scores were also linked to higher seizure responsiveness during SSIT (p < 0.05). These findings support the potential role of SSITs in accelerating diagnosis within a stepwise framework and highlight the relevance of dissociative and cognitive factors in paediatric FDS.