Whose patient are they anyway? Applying the obligation of nonabandonment to the management of patients with functional seizures

Patients with functional seizures (FS), or psychogenic non-epileptic seizures, experience episodes resembling epileptic seizures. Yet, these seizures are not caused by epileptiform brain activity, and are not treated with anti-epileptic medications. Like patients with epilepsy, patients with untreated FS are at risk of unsatisfactory quality of life and increased mortality compared to the general population. Additionally, patients with FS utilize significant healthcare resources, including repeated emergency department visits, hospitalizations, and brain studies. Despite a clear benefit to treating FS, these patients often fall through the cracks of our healthcare system. Once patients are diagnosed with FS, they are frequently discharged from Neurology clinic and referred to Psychiatry. This disruption in care can leave patients feeling dismissed and even stigmatized, and without a clear provider to treat ongoing seizures.

Existing at the intersection of Neurology and Psychiatry, FS presents an ethical dilemma for specialty providers. How should nonabandonment principles be applied to this patient population? Is it the responsibility of Neurology, Psychiatry, Emergency Departments, or patients to manage these seizures?

We studied the rates of seizure frequency and healthcare resource utilization in patients referred to a multidisciplinary clinic for functional seizures. This presentation compares seizure frequency before and after a patient is diagnosed with FS, and between treated and untreated patients. We discuss how rather than creating a divide between specialty providers, the treatment of FS creates opportunities for collaboration and continuity to treat this debilitating disorder. Finally, we provide education and policy recommendations on multidisciplinary treatment.

Wesley Kerr, MD, PhD – Clinical Instructor, Department of Neurology, Michigan Medicine, University of Michigan; Janice Firn, PhD, MSW, HEC-C – Clinical Assistant Professor, Center for Bioethics and Social Sciences in Medicine, University of Michigan; Nicholas Beimer, MD – Clinical Assistant Professor, Department of Neurology, Michigan Medicine, University of Michigan