Enhancing diagnostic yield in functional seizures: A narrative review, design and implementation of a novel ictal testing battery for video telemetry

Evaluation of behavioural impairment during functional seizures (FS) is critical for medical decision making, including accurate diagnosis, and future management recommendations. To date this type of behavioural evaluation in the setting of FS in an inpatient telemetry unit has not been closely reviewed. Here we perform a narrative review of the literature examining ictal testing and how best to improve diagnostic yield in the context of FS. We propose a novel ictal testing battery to obtain the most pertinent clinical information in people with functional seizures (PWFS). We then applied this novel ictal testing battery to patients as part of a service improvement project and compared it with the standard procedures in the video telemetry (VT) unit. This demonstrated significant improvement (Student's T-Statistic of 2.284 and a p-value of 0.014) in the amount of FS-specific information extracted as identified in the review, suggesting that such a battery is useful and can be utilised in the VT setting.