Authors :
Presenting Author: Amanda Vokoun, PT, DPT – Nationwide Children's Hospital
Laurie Enciso, RN – Nationwide Children's Hospital
Maggie Burch, MSW, LISW – Nationwide Children's Hospital
Amy Wiens, MS CPNP-AC – Nationwide Children's Hospital
Kristen Trott, PhD – Nationwide Children's Hospital
Dara Albert, DO – Nationwide Children's Hospital
Rationale:
Functional seizures (FS), also referred to as psychogenic non-epileptic seizures (PNES), are the most common subtype of functional neurological disorder (FND) in youth. The interplay of autonomic, physical, sensory, and psychological factors are involved in the diagnosis and treatment of FS. Patients can experience a variety of symptoms and differing levels of disability. A multidisciplinary team approach can ensure the patient receives an appropriate diagnosis, education, and treatment tools.
Methods:
The Functional Seizure Clinic at Nationwide Children’s Hospital, a tertiary referral center in Ohio, includes a team that aids in the evaluation and management of patients. In January 2025, a pediatric physical therapist (PT) joined the team. Patients are evaluated by PT during their first visit and if indicated, they are followed for targeted treatment in an outpatient setting. The PT evaluates functional impairments through a movement lens using the Functional Disability Inventory (FDI). The FDI is a self-reported outcome measure which assesses patients’ ability to participate in activities at home, school, and social settings. Scores above 12 indicate impactful functional impairment. During the PT evaluation, the PT also assesses potential fear avoidance behaviors, impaired proprioception, and functional movement disability. The PT engages patients in exercises that combine both upper and lower extremity movements, cross body coordination, dual tasking, and positional changes with the goal to reach an aerobic threshold.
Results:
Twenty-six new patients have been seen by the full team. The average initial reported FDI score is 12.3 out of 60 with the maximal score of 41 and minimal score of 0. Twenty-seven percent of the patients reported moderate to severe functional impairment (score >21). At this time, limited data points exist for FDI scores from follow up clinic visits. Seven additional patients with FS engaged in outpatient PT and reported improvements in both functioning and decreased FS episodes. Three out of the seven, recorded pre-post FDI data and all reported a decrease in episode frequency. The average FDI score decreased by 11.3 points.
Conclusions:
As clinical cases rise, the need for comprehensive treatment clinics for FS increases. Utilizing psychological interventions is widely used, and there is increasing evidence of the benefits of incorporating PT to address functional impairments. Our data emphasizes the presence of disability in this population and potential of utilizing a specialized physical therapist to help patients address functional impairments using movement and exercise. Early evidence suggests that a more comprehensive team approach consisting of providers from neurology, psychology, and physical therapy offers patients robust tools to address the interplay of both brain and body networks in FS management.
Funding: N/A