{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T17:22:02Z","timestamp":1776100922433,"version":"3.50.1"},"reference-count":47,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23NS135134"],"award-info":[{"award-number":["K23NS135134"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P20NS080131"],"award-info":[{"award-number":["P20NS080131"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01NS033310"],"award-info":[{"award-number":["R01NS033310"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R25NS065723"],"award-info":[{"award-number":["R25NS065723"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R25NS089450"],"award-info":[{"award-number":["R25NS089450"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R90DA022768"],"award-info":[{"award-number":["R90DA022768"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R90DA023422"],"award-info":[{"award-number":["R90DA023422"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32GM08042"],"award-info":[{"award-number":["T32GM08042"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T90DA022768"],"award-info":[{"award-number":["T90DA022768"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U24NS107158"],"award-info":[{"award-number":["U24NS107158"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000888","name":"W. M. Keck Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000888","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005339","name":"American Academy of Neurology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005339","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["K12NS098482"],"award-info":[{"award-number":["K12NS098482"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The diagnosis of functional\/dissociative seizures (FDS) without ictal video\u2010electroencephalography is challenging. The Functional\/Dissociative Seizures Likelihood Score (FSLS) is a machine learning\u2010based diagnostic score that aims to help clinicians identify FDS. We evaluated whether a human\u2010in\u2010the\u2010loop implementation of the FSLS improved the performance of clinicians identifying FDS as compared to epileptic seizures (ES).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We constructed 117 anonymized cases about patients with ictal video\u2010electroencephalography\u2010documented FDS, epilepsy, co\u2010occurring ES and FDS, or physiological seizurelike events. Text\u2010based clinical history was presented followed by the FSLS. Readers were asked the most likely diagnosis after each piece of information. We used mixture modeling combined with mixed effects logistic regression to perform data\u2010driven grouping of participants based on observed patterns of diagnostic performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, 163 readers saw 1142 cases (median\u2009=\u20094 cases\/reader), and 146 (90%) had a performance higher than chance. More formal training in seizures was associated with better performance (epileptologist accuracy\u2009=\u200967%, mental health clinician accuracy\u2009=\u200952%). Data\u2010driven groups including 66% of readers benefitted from the FSLS (accuracy improvement\u2009=\u200912%\u201315%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.05), including those in the reference and near highest baseline performance group. Other groups had no net change in performance (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u2009.75).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>Clinicians with more formal seizure training identified possible FDS more accurately than others, but formal training did not guarantee high diagnostic performance. Two performance\u2010based groups, which included 66% readers, benefitted from the FSLS because they identified when to change their mind on the basis of the FSLS's suggestion. The implementation of machine learning in the diagnosis of FDS should focus on identifying clinical settings where it can effectively enhance clinicians' decision\u2010making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epi.70069","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T18:00:19Z","timestamp":1768413619000},"page":"1748-1759","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantifying the impact of a computer\u2010aided diagnostic score on the clinical diagnosis of functional seizures"],"prefix":"10.1002","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5546-5951","authenticated-orcid":false,"given":"Wesley T.","family":"Kerr","sequence":"first","affiliation":[{"name":"Department of Neurology University of Pittsburgh  Pittsburgh Pennsylvania USA"},{"name":"Department of Neurology University of California, Los Angeles  Los Angeles California USA"},{"name":"Department of Psychiatry and Biobehavioral Sciences University of California, Los Angeles  Los Angeles California USA"},{"name":"Department of Neurology University of Michigan  Ann Arbor Michigan USA"},{"name":"Department of Biomedical Informatics University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0365-813X","authenticated-orcid":false,"given":"Katherine N.","family":"McFarlane","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7329-480X","authenticated-orcid":false,"given":"Corinne H.","family":"Allas","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California, Los Angeles  Los Angeles California USA"},{"name":"Department of Psychiatry and Biobehavioral Sciences University of California, Los Angeles  Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6179-9467","authenticated-orcid":false,"given":"Samuel W.","family":"Terman","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Michigan  Ann Arbor Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4104-6705","authenticated-orcid":false,"given":"Markus","family":"Reuber","sequence":"additional","affiliation":[{"name":"Academic Neurology Unit University of Sheffield, Royal Hallamshire Hospital  Sheffield UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7723-9317","authenticated-orcid":false,"given":"Sung Hyun","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Michigan  Ann Arbor Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1314-9887","authenticated-orcid":false,"given":"Payge","family":"Barnard","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Michigan  Ann Arbor Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4806-3743","authenticated-orcid":false,"given":"Adriana Y.","family":"Koek","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Michigan  Ann Arbor Michigan USA"},{"name":"Department of Neurology University of California, San Francisco  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3560-9433","authenticated-orcid":false,"given":"Amir H.","family":"Karimi","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California, Los Angeles  Los Angeles California USA"},{"name":"Department of Psychiatry and Biobehavioral Sciences University of California, Los Angeles  Los Angeles California USA"},{"name":"Department of Anesthesiology Harbor\u2013University of California, Los Angeles Medical Center  West Carson California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3353-5031","authenticated-orcid":false,"given":"Siddhika S.","family":"Sreenivasan","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California, Los Angeles  Los Angeles California USA"},{"name":"Department of Psychiatry and Biobehavioral Sciences University of California, Los Angeles  Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8272-5221","authenticated-orcid":false,"given":"Jena S.","family":"Grauer","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California, Los Angeles  Los Angeles California USA"},{"name":"Department of Psychiatry and Biobehavioral Sciences University of California, Los Angeles  Los Angeles California USA"},{"name":"Oregon Health Science University School of Medicine  Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6578-5142","authenticated-orcid":false,"given":"Di","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California, San Francisco  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2977-681X","authenticated-orcid":false,"given":"Meagan","family":"Watson","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Colorado  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8892-6435","authenticated-orcid":false,"given":"Elissa H.","family":"Patterson","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Michigan  Ann Arbor Michigan USA"},{"name":"Department of Psychiatry University of Michigan  Ann Arbor Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1052-8725","authenticated-orcid":false,"given":"James","family":"Castellano","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6284-8336","authenticated-orcid":false,"given":"Anto I.","family":"Bagi\u0107","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7685-9562","authenticated-orcid":false,"given":"L. Brian","family":"Hickman","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California, Los Angeles  Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth H.","family":"Kutschman","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Michigan  Ann Arbor Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2316-4676","authenticated-orcid":false,"given":"Laurence","family":"Knowles","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Exeter  Exeter UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3614-6346","authenticated-orcid":false,"given":"Alistair","family":"Wardrope","sequence":"additional","affiliation":[{"name":"Academic Neurology Unit University of Sheffield, Royal Hallamshire Hospital  Sheffield UK"},{"name":"Department of Neurology Sheffield Teaching Hospitals National Health Service Foundation Trust  Sheffield UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6057-2578","authenticated-orcid":false,"given":"Piyush","family":"Ostwal","sequence":"additional","affiliation":[{"name":"Department of Neurology Latrobe Regional Hospital  Traralgon Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9435-5157","authenticated-orcid":false,"given":"Bridget K.","family":"MacDonald","sequence":"additional","affiliation":[{"name":"Department of Neurology Croydon University Hospital  Thornton Health UK"},{"name":"Department of Neurology St. George's Hospital  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4288-7557","authenticated-orcid":false,"given":"Melissa","family":"Berry","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Michigan  Ann Arbor Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lomalan","family":"Reddy","sequence":"additional","affiliation":[{"name":"Community Epilepsy Service, Bradford Teaching Hospitals National Health Service Foundation Trust  Bradford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Najda","family":"Robinson\u2010Mayer","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Michigan  Ann Arbor Michigan USA"},{"name":"Department of Social Work University of Michigan  Ann Arbor Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8054-5769","authenticated-orcid":false,"given":"Nicholas J.","family":"Beimer","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Michigan  Ann Arbor Michigan USA"},{"name":"Department of Psychiatry University of Michigan  Ann Arbor Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachna","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pittsburgh  Pittsburgh Pennsylvania USA"},{"name":"Lake Erie College of Osteopathic Medicine  Erie Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah K.","family":"Yaghoubi","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8259-5997","authenticated-orcid":false,"given":"Laura A.","family":"Kirkpatrick","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pittsburgh  Pittsburgh Pennsylvania USA"},{"name":"Department of Pediatrics University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9382-8993","authenticated-orcid":false,"given":"Danielle R.","family":"Carns","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pittsburgh  Pittsburgh Pennsylvania USA"},{"name":"Department of Neurology Emory University  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9429-5089","authenticated-orcid":false,"given":"Alex J.","family":"Israel","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0391-345X","authenticated-orcid":false,"given":"Jamie D.","family":"Feusner","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Division of Neurosciences and Clinical Translation University of Toronto  Toronto Ontario Canada"},{"name":"Centre for Addiction and Mental Health  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1500-2589","authenticated-orcid":false,"given":"Zongqi","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4433-7839","authenticated-orcid":false,"given":"Yanshan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics University of Pittsburgh  Pittsburgh Pennsylvania USA"},{"name":"Intelligent Systems Program University of Pittsburgh  Pittsburgh Pennsylvania USA"},{"name":"Department of Health Information Management University of Pittsburgh  Pittsburgh Pennsylvania 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