Características clínicas y paraclínicas del diagnóstico de las crisis funcionales

Autores/as

  • Andrés Felipe Morcillo Muñoz Epileptología clínica, Instituto Nacional de Neurología y Neurocirugía “Manuel Velasco Suárez” (INNNMVS), Ciudad de México, México https://orcid.org/0000-0002-2738-8880

DOI:

https://doi.org/10.22379/anc.2084

Palabras clave:

Trastornos de conversión, Convulsiones, Epilepsia, Electroencefalografía, Enfermedades del sistema nervioso

Resumen

Introducción: Las crisis funcionales hacen parte de las entidades a considerar dentro del diagnóstico diferencial en la evaluación de un paciente con crisis epilépticas. El propósito de esta revisión es dilucidar los elementos clínicos y paraclínicos para un correcto diagnóstico de las crisis funcionales.

Materiales y Métodos: Se realizó una revisión narrativa de la literatura, búsqueda en bases de datos  Medline, Embase, Scielo y Scopus.

Resultados: La naturaleza paroxística de las crisis requiere un detallado análisis de las características clínicas dentro del relato del paciente o de los testigos de los eventos. El estándar de oro continúa siendo la visualización de los eventos en un video-electroencefalograma (VEEG) que permita evidenciar la ausencia de actividad epileptiforme durante la ocurrencia de las manifestaciones clínicas; el uso de neuroimágenes funcionales ha ayudado a dilucidar el entendimiento del sustento biológico este tipo de crisis. Otros estudios de laboratorio han demostrado una utilidad limitada por si solos, pero también se deben tener en cuenta en el arsenal diagnóstico.

Discusión: La presencia de factores de riesgo y especialmente la presencia de signos útiles, que se presentan con una mayor probabilidad de ocurrencia en crisis funcionales en comparación de las crisis epilépticas; asociado a la ausencia de actividad epiléptica en el registro electroencefalográfico. Un correcto y temprano diagnóstico permite evitar el uso innecesario de medicamentos anticrisis.

Conclusiones: Es crucial la identificación de las crisis funcionales con el fin de evitar la realización de estudios e intervenciones farmacológicas innecesarias, para finalmente encausar correctamente la estrategia terapéutica.

Biografía del autor/a

Andrés Felipe Morcillo Muñoz, Epileptología clínica, Instituto Nacional de Neurología y Neurocirugía “Manuel Velasco Suárez” (INNNMVS), Ciudad de México, México

Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México

Referencias bibliográficas

Stone J, Burton C, Carson A. Recognising and explaining functional neurological disorder. BMJ. 2020;371:m3745. https://doi.org/10.1136/bmj.m3745

Marín-Medina DS, Arenas Vargas PA, Arias Botero JC, Gómez Vásquez M, Santos Gonzalez CA. Trastornos neurológicos funcionales (TNF): unificando el dualismo mente-cerebro. Acta Neurol Colomb. 2024;40(4):e1888. https://doi.org/10.22379/anc.v40i4.1888

Asadi-Pooya AA. Incidence and prevalence of psychogenic nonepileptic seizures (functional seizures): a systematic review and an analytical study. Int J Neurosci. 2023;133(6):598-603. https://doi.org/10.1080/00207454.2021.1942870

Martin R, Burneo JG, Prasad A, Powell T, Faught E, Knowlton R, et al. Frequency of epilepsy in patients with psychogenic seizures monitored by video-EEG. Neurology. 2003;61(12):1791-2. https://doi.org/10.1212/01.wnl.0000098890.13946.f5

Asadi-Pooya AA, Asadollahi M, Tinker J, Nei M, Sperling MR. Post-epilepsy surgery psychogenic nonepileptic seizures. Epilepsia. 2016;57(10):1691-6. https://doi.org/10.1111/epi.13513

Azman Iste F, Ayhan Arslan G, Tezer FI, Saygi S. Psychogenic non-epileptic seizures in patients undergoing epilepsy surgery: experience from a tertiary referral center. Epilepsy Behav. 2025;171:110592. https://doi.org/10.1016/j.yebeh.2025.110592

Hingray C, Popkirov S, Kozlowska K, Pretorius C, Sarudiansky M, El-Hage W, et al. Functional/dissociative seizures: proposal for a new diagnostic label and definition by the ILAE task force. Epilepsia. 2025;66(11):4162-82. https://doi.org/10.1111/epi.18574

Wardrope A, Dworetzky BA, Barkley GL, Baslet G, Buchhalter J, Doss J, et al. How to do things with words: Two seminars on the naming of functional (psychogenic, non-epileptic, dissociative, conversion, …) seizures. Seizure. 2021;93:102-10. https://doi.org/10.1016/j.seizure.2021.10.016

Anzellotti F, Dono F, Evangelista G, Di Pietro M, Carrarini C, Russo M, et al. Psychogenic non-epileptic seizures and pseudo-refractory epilepsy, a management challenge. Front Neurol. 2020;11:461. https://doi.org/10.3389/fneur.2020.00461

Kerr MP, Mensah S, Besag F, de Toffol B, Ettinger A, Kanemoto K, et al. International consensus clinical practice statements for the treatment of neuropsychiatric conditions associated with epilepsy. Epilepsia. 2011;52(11):2133-8. https://doi.org/10.1111/j.1528-1167.2011.03276.x

Fisher RS, van Emde Boas W, Blume W, Elger C, Genton P, Lee P, et al. Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia. 2005;46(4):470-2. https://doi.org/10.1111/j.0013-9580.2005.66104.x

Leibetseder A, Eisermann M, LaFrance WC, Nobili L, von Oertzen TJ. How to distinguish seizures from non-epileptic manifestations. Epileptic Disord. 2020;22(6):716-38. https://doi.org/10.1684/epd.2020.1234

Popkirov S, Asadi-Pooya AA, Duncan R, Gigineishvili D, Hingray C, Kanner AM, et al. The aetiology of psychogenic non-epileptic seizures: risk factors and comorbidities. Epileptic Disord. 2019;21(6):529-47. https://doi.org/10.1684/epd.2019.1107

LaFrance WC, Devinsky O. The treatment of nonepileptic seizures: historical perspectives and future directions. Epilepsia. 2004;45(supl. 2):15-21. https://doi.org/10.1111/j.0013-9580.2004.452002.x

Gorenflo R, Ho R, Carrazana E, Mitchell C, Viereck J, Liow KK, et al. Identification of risk factors and distinguishing psychogenic nonepileptic seizures from epilepsy: a retrospective case-control study. Clin Neurol Neurosurg. 2022;217:107221. https://doi.org/10.1016/j.clineuro.2022.107221

Fox J, Mishra M. Hypertension and other vascular risk factors in patients with functional seizures. Epilepsy Behav. 2024;152:109650. https://doi.org/10.1016/j.yebeh.2024.109650

Watson M, Cook K, Sillau S, Greenwell E, Libbon R, Strom L. Death of a loved one: a potential risk factor for onset of functional seizures. Epilepsy Behav. 2024;155:109769. https://doi.org/10.1016/j.yebeh.2024.109769

Benbadis SR, Agrawal V, Tatum WO. How many patients with psychogenic nonepileptic seizures also have epilepsy? Neurology. 2001;57(5):915-7. https://doi.org/10.1212/wnl.57.5.915

Massot-Tarrús A, Yu YJ, AlKhateeb M, Mirsattari SM. Factors associated with comorbid epilepsy in patients with psychogenic nonepileptic seizures: a large cohort study. Epilepsy Behav. 2022;134:108780. https://doi.org/10.1016/j.yebeh.2022.108780

Reuber M, Qurishi A, Bauer J, Helmstaedter C, Fernandez G, Widman G, et al. Are there physical risk factors for psychogenic non-epileptic seizures in patients with epilepsy? Seizure. 2003;12(8):561-7. https://doi.org/10.1016/s1059-1311(03)00064-5

Doss RC, LaFrance WC. Psychogenic non-epileptic seizures. Epileptic Disord. 2016;18(4):337-43. https://doi.org/10.1684/epd.2016.0873

Asadi-Pooya AA, Homayoun M. Psychogenic nonepileptic seizures: the sex ratio trajectory across the lifespan. Seizure. 2020;75:63-5. https://doi.org/10.1016/j.seizure.2019.12.017

Catherine CRK, Waters JFR, Urban A, Kerr WT. Pregnancy outcomes and changes to seizure frequency during pregnancy for patients with functional seizures. Epilepsy Behav. 2025;171:110501. https://doi.org/10.1016/j.yebeh.2025.110501

Alkhaldi NA, Paredes-Aragón E, Kim DD, Yu YJ, ALKhateeb M, Mirsattari SM. Psychogenic non-epileptic seizures with and without epilepsy: Exploring the influence of co-existing psychiatric disorders on clinical characteristics and outcomes. Epilepsy Res. 2024;199:107279. https://doi.org/10.1016/j.eplepsyres.2023.107279

Lazzari C, Nikolou-Walker E, Liu LQ, Rabottini M. Psychiatric comorbidities in functional neurological disorders and psychogenic non-epileptic seizures: a systematic review and policy recommendations for improving assessment and treatment. Neuropsychiatr Dis Treat. 2024;20:2313-31. https://doi.org/10.2147/ndt.s491376

Asadi-Pooya AA, Farazdaghi M. Functional seizures: cluster analysis may predict the associated risk factors. Epilepsy Behav. 2022;126:108485. https://doi.org/10.1016/j.yebeh.2021.108485

Asadi-Pooya AA, Bahrami Z. Auras in psychogenic nonepileptic seizures. Seizure. 2019;69:215-7. https://doi.org/10.1016/j.seizure.2019.05.012

Asadi-Pooya AA, Valente K, Alessi R, Tinker J. Semiology of psychogenic nonepileptic seizures: an international cross-cultural study. Epilepsy Behav. 2017;75:210-2. https://doi.org/10.1016/j.yebeh.2017.08.016

Benbadis SR, LaFrance WC. Clinical features and the role of video-EEG monitoring. En: LaFrance WC, Schachter SC, editores. Gates and Rowan’s Nonepileptic Seizures. Cambridge: Cambridge University Press; 2018. p. 44-57.

Dworetzky BA, Mortati KA, Rossetti AO, Vaccaro B, Nelson A, Bromfield EB. Clinical characteristics of psychogenic nonepileptic seizure status in the long-term monitoring unit. Epilepsy Behav. 2006;9(2):335-8. https://doi.org/10.1016/j.yebeh.2006.06.007

Jungilligens J, Michaelis R, Popkirov S. Misdiagnosis of prolonged psychogenic non-epileptic seizures as status epilepticus: epidemiology and associated risks. J Neurol Neurosurg Psychiatry. 2021;92(12):1341-5. https://doi.org/10.1136/jnnp-2021-326443

Lehn A, Watson E, Ryan EG, Jones M, Cheah V, Dionisio S. Psychogenic nonepileptic seizures treated as epileptic seizures in the emergency department. Epilepsia. 2021;62(10):2416-25. https://doi.org/10.1111/epi.17038

Viarasilpa T, Panyavachiraporn N, Osman G, Kowalski RG, Miller J, Barkley GL, et al. Differentiation of psychogenic nonepileptic attacks from status epilepticus among patients intubated for convulsive activity. Epilepsy Behav. 2021;115:107679. https://doi.org/10.1016/j.yebeh.2020.107679

Seneviratne U, Reutens D, D'Souza W. Stereotypy of psychogenic nonepileptic seizures: insights from video-EEG monitoring. Epilepsia. 2010;51(7):1159-68. https://doi.org/10.1111/j.1528-1167.2010.02560.x

Azman Iste F, Yon MI, Tezer FI, Saygi S. Ictal crying in epileptic seizures and psychogenic nonepileptic seizures: what are the hints to differentiate them? Epilepsy Behav. 2023;147:109385. https://doi.org/10.1016/j.yebeh.2023.109385

Brigo F, Storti M, Lochner P, Tezzon F, Fiaschi A, Bongiovanni LG, et al. Tongue biting in epileptic seizures and psychogenic events: an evidence-based perspective. Epilepsy Behav. 2012;25(2):251-5. https://doi.org/10.1016/j.yebeh.2012.06.020

Brigo F, Nardone R, Ausserer H, Storti M, Tezzon F, Manganotti P, et al. The diagnostic value of urinary incontinence in the differential diagnosis of seizures. Seizure. 2013;22(2):85-90. https://doi.org/10.1016/j.seizure.2012.10.011

Avbersek A, Sisodiya S. Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures? J Neurol Neurosurg Psychiatry. 2010;81(7):719-25. https://doi.org/10.1136/jnnp.2009.197996

Syed TU, LaFrance WC, Kahriman ES, Hasan SN, Rajasekaran V, Gulati D, et al. Can semiology predict psychogenic nonepileptic seizures? A prospective study. Ann Neurol. 2011;69(6):997-1004. https://doi.org/10.1002/ana.22345

Sundararajan T, Tesar GE, Jimenez XF. Biomarkers in the diagnosis and study of psychogenic nonepileptic seizures: a systematic review. Seizure. 2016;35:11-22. https://doi.org/10.1016/j.seizure.2015.12.011

Seneviratne U, Minato E, Paul E. How reliable is ictal duration to differentiate psychogenic nonepileptic seizures from epileptic seizures? Epilepsy Behav. 2017;66:127-31. https://doi.org/10.1016/j.yebeh.2016.10.024

Marín-Medina DS, Ortega-Quintero AP, Arenas-Vargas PA, Arias-Botero JC, Ramírez-Molina JL. Functional neurological disorders among hospitalized patients in a resource-limited setting: current situation in Colombia and paths to improvement. Neurol Sci. 2025;46(12):6843-50. https://doi.org/10.1007/s10072-025-08416-z

Dietze CS, van Gorp TC, Meppelink AM, Jansen FE, LaFrance WC, van der Salm SMA, et al. Functional seizures: Scoping review of classifications and proposal of novel three-axis model. Epilepsy Behav. 2025;171:110484. https://doi.org/10.1016/j.yebeh.2025.110484

Hampel KG, Garces-Sanchez M, Gomez-Ibanez A, Palanca-Camara M, Villanueva V. [Diagnostic challenges in epilepsy]. Rev Neurol. 2019;68(6):255-63. https://doi.org/10.33588/rn.6806.2018242

Sheldon R, Rose S, Ritchie D, Connolly SJ, Koshman ML, Lee MA, et al. Historical criteria that distinguish syncope from seizures. J Am Coll Cardiol. 2002;40(1):142-8. https://doi.org/10.1016/s0735-1097(02)01940-x

Benbadis SR, Lancman ME, King LM, Swanson SJ. Preictal pseudosleep: a new finding in psychogenic seizures. Neurology. 1996;47(1):63-7. https://doi.org/10.1212/wnl.47.1.63

Wang YQ, Wen Y, Wang MM, Zhang YW, Fang ZX. Prolactin levels as a criterion to differentiate between psychogenic non-epileptic seizures and epileptic seizures: a systematic review. Epilepsy Res. 2021;169:106508. https://doi.org/10.1016/j.eplepsyres.2020.106508

Mcsweeney M, Reuber M, Levita L. Neuroimaging studies in patients with psychogenic non-epileptic seizures: a systematic meta-review. Neuroimage Clin. 2017;16:210-21. https://doi.org/10.1016/j.nicl.2017.07.025

Patel J, Tran QK, Martinez S, Wright H, Pourmand A. Utility of serum lactate on differential diagnosis of seizure-like activity: a systematic review and meta-analysis. Seizure. 2022;102:134-42. https://doi.org/10.1016/j.seizure.2022.10.007

Kanbayashi T, Brown K, Stone J. Oxygen desaturation in patients with functional seizures: pitfalls for the unwary. Pract Neurol. 2026:pn-2025-004868. https://doi.org/10.1136/pn-2025-004868

LaFrance WC, Baker GA, Duncan R, Goldstein LH, Reuber M. Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: a staged approach: a report from the International League Against Epilepsy Nonepileptic Seizures Task Force. Epilepsia. 2013;54(11):2005-18. https://doi.org/10.1111/epi.12356

Cómo citar

Morcillo Muñoz, A. F. (2026). Características clínicas y paraclínicas del diagnóstico de las crisis funcionales. Acta Neurológica Colombiana. https://doi.org/10.22379/anc.2084

Descargas

Los datos de descargas todavía no están disponibles.

Descargas

Publicado

21-05-2026

Número

Sección

Revisión
Crossref Cited-by logo
Escanea para compartir
QR Code
Estadísticas de artículo
Vistas de resúmenes
Vistas de PDF
Descargas de PDF
Vistas de HTML
Otras vistas

Algunos artículos similares: