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The A to F of functional status in the acute setting: A scoping review

  • Author Footnotes
    1 TE and SE contributed equally to this paper.
    Talia Eilon
    Correspondence
    Corresponding author at: Flat 6, 127 Stoke Newington Road, Hackney, London N16 8BT, United Kingdom.
    Footnotes
    1 TE and SE contributed equally to this paper.
    Affiliations
    Department of Neuropsychiatry, South West London and St George's Mental Health Trust, London, & St George's, University of London, Flat 6, 127 Stoke Newington Road, Hackney, London N16 8BT, United Kingdom

    Department of Forensic Psychiatry, Chase Farm Hospital, Barnet, Enfield and Haringey Mental Health Trust, United Kingdom
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  • Author Footnotes
    1 TE and SE contributed equally to this paper.
    Samia Elkommos
    Footnotes
    1 TE and SE contributed equally to this paper.
    Affiliations
    School of Neuroscience, King's College London, United Kingdom

    Atkinson Morley Regional Neurosciences Centre, St George's University Hospitals and St George's, University of London, United Kingdom
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  • Sevag Ouzounian
    Affiliations
    Department of Forensic Psychiatry, South West London and St George's Mental Health Trust, United Kingdom
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  • Yousif Salih
    Affiliations
    Department of Neuropsychiatry, South West London and St George's Mental Health Trust, London, & St George's, University of London, Flat 6, 127 Stoke Newington Road, Hackney, London N16 8BT, United Kingdom
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  • Niruj Agrawal
    Affiliations
    Department of Neuropsychiatry, South West London and St George's Mental Health Trust, London, & St George's, University of London, Flat 6, 127 Stoke Newington Road, Hackney, London N16 8BT, United Kingdom
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  • Mahinda Yogarajah
    Affiliations
    Department of Clinical and Experimental Epilepsy, Institute of Neurology, UCL, United Kingdom

    National Hospital for Neurology and Neurosurgery, UCLH, United Kingdom

    Epilepsy Society, London, United Kingdom
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  • Norman Poole
    Affiliations
    Department of Neuropsychiatry, South West London and St George's Mental Health Trust, London, & St George's, University of London, Flat 6, 127 Stoke Newington Road, Hackney, London N16 8BT, United Kingdom
    Search for articles by this author
  • Author Footnotes
    1 TE and SE contributed equally to this paper.
Published:September 23, 2022DOI:https://doi.org/10.1016/j.seizure.2022.09.015

      Highlights

      • There is a lack of available guidance in the existing literature on the acute management of Functional Status (FSt).
      • Using a staged approach combining clinical history, examination, video-EEG and serum markers can clarify the level of certainty of an FSt diagnosis in the emergency setting.
      • Management of FSt can be separated into acute and longer-term interventions.
      • A multi-disciplinary team approach involving neurology and psychiatry services is recommended for the management of FSt.

      Abstract

      Functional status (FSt) describes the phenomenon of prolonged non-epileptic attacks that may be misidentified as Status Epilepticus (SE). The early differentiation between epileptic and functional status is crucial in order to avoid unnecessarily invasive and costly medical escalation in the latter group, including the hazards of overmedication, intubation and intensive care admission. The authors conducted a literature review of available studies describing cases of functional status to extract the common aspects of FSt seizure semiology, investigations used to differentiate from SE, and guidance for managing FSt. A search was carried out using Medline, Embase and PsychInfo databases and 3909 papers were extracted for review. 30 papers were found relevant for inclusion, describing 260 cases of FSt. FSt was found to occur more commonly in younger, female patients with a family history of epilepsy, co-morbid psychiatric diagnosis and following a recent traumatic event. Common clinical features of FSt during and after, the events were identified. While video-EEG remains the gold standard investigation for differentiating FSt from SE, many of the included studies considered the utility of other investigation modalities including serum markers and neuroimaging. One key shortcoming identified within the literature reviewed was a lack of well-defined guidance on the acute management of FSt. We offer an A-F step management plan for the immediate and longer term assessment and treatment of FSt.

      Keywords

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