Functional neurological symptom disorder (FND) is characterized by the ideogenic neurologic presentation deriving from unconscious stressors or conflicts. The symptoms of FND usually begin with a psychiatric illness—most commonly depression, but with the release of the latest version of International Classification of Diseases-11 (ICD-11), a new favoring factor comes to our mind: prolonged grief disorder (PGD), the newcomer to psychopathology.

The purpose of this case-report is to highlight the several key differences between PGD and depression, and the role of PGD in the onset of FND.

The authors report the case of a 22 years old woman with a history of frequent seizures with loss of consciousness and the absence of stimulus-response, which started soon after the death of her 31 years old brother. Psychologically, the patient presented sustained interest in the deceased, self-blame, confusion, emptiness and low mood. On a physical exam, the patient showed periocular hyperpigmentation.

The emergent symptoms and signs were resistant, failed to resolve with medication alone and continued to persist across all settings. The neurological dysfunction remained present and interfered with the patient’s functioning, until applying grief-oriented psychotherapy, which was the most efficient approach.

In conclusion, PGD represents a favoring condition for the onset of FND and it is most often mistaken with depression. Therefore, it is crucial to distinguish between these two disorders, as there is solid evidence that treatment for depression is far less helpful than targeted grief treatment.

No significant relationships.

Ictal semiology interpretation for differentiating psychogenic nonepileptic seizures (PNESs) and epileptic seizures (ESs) is important for the institution of appropriate treatment. Our objective was to assess the ability of different health care professionals (HCPs) or students to distinguish PNES from ES based on video-recorded seizure semiology.

This study was designed following the Standards for Reporting of Diagnostic Accuracy Studies (STARD) guidelines. We showed in a random mix 36 videos of PNES or ES (18 each) and asked 558 participants to classify each seizure. The diagnostic accuracy of various groups of HCPs or students for PNES versus ES was assessed, as well as the effect of patient age and sex. Measures of diagnostic accuracy included sensitivity, specificity, and area under the curve (AUC).

The descending order of diagnostic accuracy (AUC) was the following (p ≤ 0.001): (1) neurologists and epileptologists; (2) neurology residents; (3) other specialists and nurses with experience in epilepsy; and (4) undergraduate medical students. Although there was a strong trend toward statistical difference, with AUC 95% confidence intervals (CIs) that were not overlapping, between epileptologists (95% CI 93, 97) compared to neurologists (95% CI 88, 91), and neurologists compared to electroencephalography technicians (95% CI 82, 87), multiple pairwise comparisons with the conservative Tukey–Kramer honest significant difference test revealed no statistical difference (p = 0.25 and 0.1, respectively). Patient age and sex did not have an effect on diagnostic accuracy in neurology specialists.

Visual recognition of PNES by HCPs or students varies overall proportionately with the level of expertise in the field of neurology/epilepsy.