Abstract
INTRODUCTION: Functional seizures, a subtype of functional neurological disorder, are frequent presentations within the emergency department and wider hospital setting. There is a lack of research exploring pre-hospital care for this patient group. The aim of this service evaluation was to explore ambulance staff recognition, care and management of functional seizure presentations within a UK ambulance service trust.
METHODS: An online survey was conducted using a convenience sample of clinical staff from South Western Ambulance Services NHS Foundation Trust. Respondents were asked for a mixture of distinct and free-text answers to questions around identification, care and management of functional seizure presentations. Results were analysed using a mix of descriptive statistics and qualitative content analysis.
RESULTS: There were 96 responses to the survey. Eighty-two per cent (n = 81) of respondents reported that they attend functional seizures at least once monthly, with 18% (n = 17) of those attending functional seizures weekly. Ambulance staff confidence in the recognition and management of functional seizures is high, but notably 66% (n = 63) have received no previous training or education for functional seizure care. Definitions and causes of functional seizures reportedly relied predominantly on a psychological component. Identification was based on history, seizure features and clinical guidelines. Management of functional seizures focused on reassurance. Challenges identified by ambulance staff included stigma, perceived diagnostic complexity, fear and limited education.
CONCLUSION: Ambulance staff frequently attend functional seizures but receive limited training, leading to misconceptions, stigma and diagnostic challenges. Identification depends on unreliable signs and complex histories. Management aligns with clinical guidance, yet uncertainty remains for prolonged events. Fear of misdiagnosis, harmful attitudes and poor education highlight the urgent need for targeted education and future research.