Collaborative online therapy program sees functional seizures almost halve within weeks
An innovative telehealth therapy program that has patients and clinicians working together to solve the puzzle of functional seizures has generated better awareness of triggers and dramatic reductions in symptoms.
People living with functional seizures — sudden episodes that resemble epileptic seizures but aren't caused by abnormal electrical activity in the brain — often fall through the cracks of the medical system.
Functional seizures have a similar mortality rate to drug-resistant epilepsy. One in four people admitted to hospital for epilepsy evaluation will ultimately be diagnosed with functional seizures.
“Functional seizures look like epileptic seizures, but there’s no electrical storm in the brain,” says Dr Lana Higson, an Alfred Health clinical neuropsychologist and research fellow at the School of Translational Medicine’s department of Neuroscience.
“They can involve shaking, speech difficulties, spasms, and even unresponsiveness.
FND mostly affects women, usually beginning in young adulthood. Underlying the condition is a complex interplay of environmental, genetic, and psychological factors. It’s often misdiagnosed, under diagnosed and stigmatised.
Recognising there was nowhere for people to go in the public system, a multidisciplinary Functional Seizure Clinic at The Alfred Hospital — Australia’s first and only one of its kind — was launched in 2019, integrating neurology, psychiatry, and psychology.
“People with functional seizures often get passed between neurologists and psychologists, with no one quite sure where they fit,” Dr Higson said. “Working together lets us see the full picture and tailor treatments more effectively.”
This led to development of a novel therapy program, Re-PROGRAM, by Dr Higson and her team. Initially delivered via telehealth, it was designed around the realities of people living with the condition — such as difficulties with driving, cost, and limited access to care.
“We spoke directly to patients,” she said. “We asked them what was helpful and what wasn’t, and built the therapy around that feedback.”
In a departure from standard FND care, Re-PROGRAM focuses on reducing functional symptoms - such as muscle weakness, movement problems, sensory symptoms, and convulsions - rather than associated issues like anxiety or depression.
It takes an open-ended, collaborative approach: clinicians set aside preconceived ideas of the cause, to help patients to discover their own seizure triggers over time. “Instead of telling people why we think their seizures are happening, we explore it together. It's like solving a jigsaw puzzle — they hold the pieces, and we help guide them.”
The program starts with lifestyle changes like exercise, sleep, and nutrition. “These are modifiable targets that can help regulate the nervous system,” Dr Higson said. “We use practical tools to improve body awareness, and teach people to recognise and respond to physical cues that could signal a seizure.”
To evaluate Re-PROGRAM, Dr Higson’s team ran one of the world’s largest randomised controlled trials (RCTs) on functional seizures. They tested both therapist-guided and self-guided online versions of the program against standard care. The results were promising.
“In the self-guided group, seizure frequency almost halved within six to 12 weeks,” she revealed. “We also saw reductions in anxiety and depression, especially for those who also lived with chronic pain or anxiety.”
Perhaps surprisingly, some patients said they wouldn't want their seizures to disappear entirely. “For some people, seizures serve a function — like forcing rest, signalling emotional distress, or even offering a strange sense of control,” Dr Higson explained (you can read more about this in her 2024 paper, ‘What are your seizures telling you?’).
Not everyone improved with a short-term intervention. So the team is now working on expanding available options — including long-term therapy for more complex cases, and support modules for families.
“There’s still a lot to learn,” she said. “But what’s clear is that we need to work with patients and not do things to them. We’re on the same side of the table.”
The team is now exploring ways they can make the self-guided program publicly available — and potentially, globally accessible. “It’s low-cost, scalable, and could offer immediate help to people newly diagnosed while they wait for further care.”
Dr Higson envisages a future where people can start the program immediately after a diagnosis, providing timely support while they wait for further treatment.
This story is based on an FND Awareness Foundation webinar presented by Dr Higson for FND Awareness Day 2025.