REFERENCE · DIAGNOSTIC TECHNIQUE

Typical-Event Assessment and Video-EEG

Clinician-focused educational reference. Other readers are welcome; this is not a home diagnostic test.

Purpose and Suitability
Anatomy and Physiology
Preparation and Safety
Performing the Assessment
Interpreting Findings
Explaining the Result
Evidence and Limitations
Media and Accessibility
Research and Sources

Purpose and Suitability

This assessment asks what each recurring event is and how securely the evidence supports that conclusion. It combines history, witness information and, when feasible, synchronized video and EEG of a habitual event. It is especially useful when epilepsy and functional seizures remain difficult to distinguish or there is more than one event type. [1]

Habitual or typical event: An episode recognized as representative of the person’s usual events. Video-EEG: Simultaneous video recording and measurement of brain electrical activity from scalp electrodes.

The relevant question is not simply whether the EEG looks normal. A monitoring admission in which no usual event occurs may leave the main question unanswered.

Anatomy and Physiology

Scalp EEG detects electrical voltage differences produced by populations of brain cells. It samples activity that reaches the scalp; it does not record every cell or every possible seizure discharge. Video shows behaviour and its timing relative to the signal.

Ictal: During a seizure. Interictal: Between seizures. Artifact: Signal caused by movement, muscle activity, equipment or another source that can obscure the brain recording.

Some focal epileptic seizures have little or no clear scalp change, and vigorous movement can obscure the trace. The examiner must decide whether an epileptic event of the observed type would be expected to produce a detectable pattern. A normal recording between events does not exclude epilepsy. [2]

Preparation and Safety

Agree the diagnostic question and recording consent, including who may view the material. Discuss positioning, transfers, sensory sensitivities, communication access, usual injuries and recovery needs. Explain any planned activation procedure and alternatives; obtain specific consent according to the service protocol.

Medication reduction, sleep restriction, flashing lights or breathing activation must only occur when clinically indicated and supervised by the monitoring team. This page is not a provocation protocol. Do not ask the person or supporters to recreate episodes at home. Deception or painful testing has no place in this teaching outline.

Have an individualized emergency response available. Staff must assess airway, breathing, injury and other urgent needs when indicated; recording never takes priority over care. [1][2]

Performing the Assessment

Create an event inventory. Ask whether there is one recurring type or several, and document the sequence, duration, frequency, triggers, injuries, recovery and treatment already given for each.
Obtain the patient’s account and, with permission, a factual witness account. Review an available home video only if it was recorded without delaying care or provoking the event.
Consider epilepsy, syncope, sleep disorders, migraine, movement disorders, metabolic causes and cardiac causes according to the presentation. Do not let an established FND diagnosis end this differential.
When feasible and clinically appropriate, arrange video-EEG monitoring intended to capture every typical event type under consideration. Record whether the patient and witness recognize the captured event as typical.
Interpret clinical semiology and simultaneous EEG together. An event without an ictal EEG correlate is not automatically functional; some epileptic seizures have limited or obscured scalp-EEG changes.
State the level of diagnostic certainty, which event type the conclusion applies to, and whether coexisting epilepsy remains present or possible.
Explain the positive evidence clearly and provide a practical event-management and follow-up plan.

This retained outline organizes clinical practice; it is not a validated seven-item score. [1][2]

During a suitable event, trained staff may use a simple spoken instruction or ask the person to remember a word for later. Document what was asked and the response, including limits from hearing, language or inability to speak. Do not equate inability to answer with absence of awareness. Review the recording before, during and after the event, then ask the person and available witness whether it matches the relevant habitual type. [2]

Interpreting Findings

Evidence supporting functional seizures: A representative event with a compatible clinical pattern and a recording that supports the specialist’s conclusion after considering scalp-EEG limitations and alternative physiological events.

Evidence supporting epilepsy: An appropriate electroclinical relationship or other convincing specialist evidence requires an epilepsy formulation, including possible coexistence with functional events.

Indeterminate: No habitual event, inadequate recording, extensive artifact, an unfamiliar induced event or unresolved competing explanations. State what remains unanswered; “no seizure captured” is not the same as “functional seizure confirmed.” [1][2]

The ILAE framework names possible, probable, clinically established and documented levels of certainty. These are evidence categories, not a severity scale. Apply the published requirements rather than assigning a level from one observation. Access limitations can justify a staged assessment and treatment plan without overstating certainty. [1][3]

One captured event does not classify every event the person has. Nor does the recording measure daily support needs, recovery time across a week or safe independence.

Explaining the Result

An editorial example, to use only when it matches the evidence:

“We recorded the episode you both recognized as your usual shaking event. The way it unfolded, together with the EEG, supports a functional seizure. I will explain the findings we used. Your separate brief episodes have not been recorded, so we still need a plan for those.”

For an inconclusive recording: “Your usual episode did not happen during this test. That limits what we can conclude.”

Offer the explanation in writing, allow questions and specify who will review uncertainty. A useful conclusion identifies the event, evidence, remaining questions and practical next steps.

Evidence and Limitations

The AAN guideline recommends history and witness information, assessment for coexisting epilepsy and use of video-EEG where feasible to resolve ambiguity. Its clinician summary was reviewed; the complete evidence supplement was not independently reappraised. [1]

Whitehead and colleagues provide practice guidance, not a new diagnostic-accuracy cohort. Their review emphasizes recording quality, habitual-event confirmation and risks of overlooking scalp-negative epilepsy or overinterpreting interictal findings. Some historical bedside suggestions in that paper are not reproduced here as instructions. [2]

The 2013 ILAE report is a consensus framework. Its staged approach is corroborated in current AAN guidance; fresh full-text review of all its original criteria remains pending. No universal sensitivity or specificity is assigned to this whole pathway. [3]

Targeted update: October 1, 2026. Diagnostic certainty and severity must be recorded separately.

Media and Accessibility

The preferred first contribution is an annotated process diagram:

Patient and witness describe each usual event type.
Video and EEG are recorded at the same time.
The captured event is confirmed as typical.
A specialist interprets behaviour, EEG and clinical context together.

If an authentic clinical recording is used, it must come from an event that occurred during clinically indicated monitoring and have separate, specific permission for public use. Show the synchronized video and EEG context before any short excerpt. Never induce, prolong or repeat a seizure solely to create educational media, and never present an isolated gesture as diagnostic.

Provide a plain-text description and transcript, with no flashing animation or requirement to watch seizure footage. Label a schematic EEG as illustrative, not a diagnostic sample. No media has been added.

Research and Sources

The sources serve different purposes: current professional recommendations, practical recording guidance and staged diagnostic-certainty consensus. None establishes that absent scalp epileptic activity alone proves a functional cause.

Citation	Figure	Full citation
[1]	—	Tolchin B, Goldstein LH, Reuber M, et al. Management of functional seizures practice guideline executive summary: report of the AAN Guidelines Subcommittee. Neurology. 2026;106(1):e214466. FND-CIT-0010. https://doi.org/10.1212/WNL.0000000000214466 AAN clinician summary.
[2]	—	Whitehead K, Kane N, Wardrope A, Kandler R, Reuber M. Proposal for best practice in the use of video-EEG when psychogenic non-epileptic seizures are a possible diagnosis. Clinical Neurophysiology Practice. 2017;2:130–139. DOI. Full text. FND-CIT-0233.
[3]	—	LaFrance WC, Baker GA, Duncan R, et al. 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):2005-2018. DOI. PMID: 24111933. FND-CIT-0146.