{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T13:01:17Z","timestamp":1791291677002,"version":"4.1.0"},"reference-count":34,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n Both epilepsy and functional\/dissociative seizures (FDS) can present with a wide variety of event manifestations which can appear similar in nature and contribute to misdiagnosis. Whereas many studies have addressed the misdiagnosis of FDS as epilepsy, research into the inverse, where epilepsy is mistaken for a functional disorder, remains limited. Accurate differentiation is vital, because management differs greatly, ranging from antiseizure medications and surgery to specialized mental health interventions.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective review was conducted of patients undergoing video\u2010electroencephalographic monitoring (VEM) at a level 4 advanced epilepsy center between 2015 and 2023. VEM reports rather than video were reviewed. Patients were categorized into three primary groups: correctly diagnosed focal epilepsy, correctly diagnosed FDS, and misdiagnosed epilepsy (patients initially diagnosed with FDS but confirmed to have epileptic seizures). A fourth group of cases with FDS that were misdiagnosed as epilepsy were excluded.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Epilepsy cases that were misdiagnosed as FDS represented 6% of the total cohort. Fifty percent (\n n<\/jats:italic>\n =\u200913) were male, and the mean age was 33.3 (range\u2009=\u200910\u201362). Compared to correctly diagnosed epilepsy, the misdiagnosed cases were significantly more likely to have semiological features, consisting of complex motor movements (\n p<\/jats:italic>\n \u2009=\u2009.0009), hyperkinetic activity (\n p<\/jats:italic>\n \u2009=\u2009.0095), and affective symptoms like fear (\n p<\/jats:italic>\n \u2009=\u2009.0001). Notably, frontal lobe epilepsy was proportionally more common in misdiagnosed cases. In contrast, events in cases with correctly diagnosed FDS were characterized by unresponsiveness (\n p<\/jats:italic>\n \u2009=\u2009.0001), hypotonia (\n p<\/jats:italic>\n \u2009=\u2009.0001), and eye closure (\n p<\/jats:italic>\n \u2009=\u2009.019), alongside prolonged duration (\n p<\/jats:italic>\n \u2009=\u2009.0001) and fluctuating semiology (\n p<\/jats:italic>\n \u2009=\u2009.0001). These features were almost entirely absent in the misdiagnosed group. FDS cases also had a significantly higher number of distinct event types but fewer semiological features per event (\n p<\/jats:italic>\n \u2009=\u2009.03). Lateralizing signs were also an indicator of an epilepsy diagnosis, appearing in 58% of misdiagnosed cases compared to only 17% of FDS cases (\n p<\/jats:italic>\n \u2009<\u2009.0001).\n <\/jats:p>\n <\/jats:sec>\n \n Significance<\/jats:title>\n Sole reliance on individual signs of FDS can lead to diagnostic errors, particularly in frontal lobe epilepsy. To improve diagnostic certainty, clinicians should analyze the temporal evolution of semiology over isolated motor manifestations. When hyperkinetic or affective symptoms are present, a thorough clinical history and assessment of the temporal evolution of semiology should improve diagnostic certainty and reduce the chances of misdiagnosis.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/epi.70487","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T12:48:36Z","timestamp":1791290916000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical characteristics and semiological pitfalls in patients with focal epilepsy and functional\/dissociative seizures: A comparative analysis of correct and incorrect initial diagnoses"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1909-4516","authenticated-orcid":false,"given":"Lisa","family":"Gillinder","sequence":"first","affiliation":[{"name":"Neurology Department Princess Alexandra Hospital Brisbane Queensland Australia"},{"name":"Mater Research Institute, University of Queensland Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3551-7010","authenticated-orcid":false,"given":"Alexander","family":"Lehn","sequence":"additional","affiliation":[{"name":"Neurology Department Princess Alexandra Hospital Brisbane Queensland Australia"},{"name":"School of Biomedical Sciences Queensland University of Technology Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunter","family":"Hartel","sequence":"additional","affiliation":[{"name":"Department of Statistics QIMR Berghofer Medical Research Institute Herston Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"issue":"11","key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"4162","DOI":"10.1111\/epi.18574","article-title":"Functional\/dissociative seizures: proposal for a new diagnostic label and definition by the ILAE task force","volume":"66","author":"Hingray C","year":"2025","journal-title":"Epilepsia"},{"issue":"6","key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1684\/epd.2019.1107","article-title":"The aetiology of psychogenic non\u2010epileptic seizures: risk factors and comorbidities","volume":"21","author":"Popkirov S","year":"2019","journal-title":"Epileptic Disord"},{"issue":"1","key":"e_1_2_12_4_1","doi-asserted-by":"crossref","DOI":"10.1212\/WNL.0000000000214466","article-title":"Management of Functional Seizures Practice Guideline Executive Summary: report of the AAN guidelines subcommittee","volume":"106","author":"Tolchin B","year":"2026","journal-title":"Neurology"},{"issue":"11","key":"e_1_2_12_5_1","doi-asserted-by":"crossref","first-page":"2182","DOI":"10.1111\/epi.16350","article-title":"Characteristics of 698 patients with dissociative seizures: a UK multicenter study","volume":"60","author":"Goldstein LH","year":"2019","journal-title":"Epilepsia"},{"key":"e_1_2_12_6_1","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.seizure.2016.06.015","article-title":"Diagnostic delay in psychogenic seizures and the association with anti\u2010seizure medication trials","volume":"40","author":"Kerr WT","year":"2016","journal-title":"Seizure"},{"issue":"11","key":"e_1_2_12_7_1","doi-asserted-by":"crossref","first-page":"1620","DOI":"10.1212\/01.wnl.0000224953.94807.be","article-title":"Avoiding the costs of unrecognized psychological nonepileptic seizures","volume":"66","author":"LaFrance WC","year":"2006","journal-title":"Neurology"},{"issue":"3","key":"e_1_2_12_8_1","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1176\/jnp.2009.21.3.292","article-title":"Evaluating patients with suspected nonepileptic psychogenic seizures","volume":"21","author":"Marchetti RL","year":"2009","journal-title":"J Neuropsychiatry Clin Neurosci"},{"key":"e_1_2_12_9_1","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.cnp.2017.06.002","article-title":"Proposal for best practice in the use of video\u2010EEG when psychogenic non\u2010epileptic seizures are a possible diagnosis","volume":"2","author":"Whitehead K","year":"2017","journal-title":"Clin Neurophysiol Pract"},{"issue":"6","key":"e_1_2_12_10_1","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1002\/ana.22345","article-title":"Can semiology predict psychogenic nonepileptic seizures? 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A clinical and polygraphic overview of 100 consecutive cases","volume":"122","author":"Provini F","year":"1999","journal-title":"Brain"},{"key":"e_1_2_12_32_1","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.seizure.2016.11.023","article-title":"From nocturnal frontal lobe epilepsy to sleep\u2010related Hypermotor epilepsy: a 35\u2010year diagnostic challenge","volume":"44","author":"Tinuper P","year":"2017","journal-title":"Seizure"},{"issue":"2","key":"e_1_2_12_33_1","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/brain\/awl322","article-title":"Surgical treatment of drug\u2010resistant nocturnal frontal lobe epilepsy","volume":"130","author":"Nobili L","year":"2007","journal-title":"Brain"},{"key":"e_1_2_12_34_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.yebeh.2022.108660","article-title":"Profile of personality in frontal and temporal lobe epilepsy: a study using the Millon clinical multiaxial inventory\u2010III","volume":"129","author":"Parente A","year":"2022","journal-title":"Epilepsy Behav"},{"key":"e_1_2_12_35_1","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.yebeh.2018.10.010","article-title":"Dual diagnosis of epilepsy and psychogenic nonepileptic seizures: systematic review and meta\u2010analysis of frequency, correlates, and outcomes","volume":"89","author":"Kutlubaev MA","year":"2018","journal-title":"Epilepsy Behav"}],"container-title":["Epilepsia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/epi.70487","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/epi.70487","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/epi.70487","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T12:48:41Z","timestamp":1791290921000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/epi.70487"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,6]]},"references-count":34,"alternative-id":["10.1002\/epi.70487"],"URL":"https:\/\/doi.org\/10.1002\/epi.70487","archive":["Portico"],"relation":{},"ISSN":["0013-9580","1528-1167"],"issn-type":[{"value":"0013-9580","type":"print"},{"value":"1528-1167","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,6]]},"assertion":[{"value":"2026-05-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"epi.70487"}}