Sense of control, selective attention and cognitive inhibition in pediatric functional seizures: A prospective case-control study
Open accessAbstract
Purpose To date, laboratory-based experimental behavioral methods have not been used to identify factors associated with pediatric functional seizures (FS), leaving a critical gap for effective treatment development.Methods Children ages 13-18 with video-EEG-confirmed FS were matched to controls (MCs) based on income, sex, race, and age. A modified Stroop task which included a condition requiring participants to report the ink colors in which seizure symptom words were written (e.g., "shaking" in blue) measured selective attention and cognitive inhibition through response time. The magic and turbulence task assessed sense of control in three conditions (magic, lag, turbulence). Children with FS were asked to report premonitory symptoms predicting FS.Results Participants included 26 children with FS and 26 MCs (Mean age=15.2, 74% female, 59% white). On Stroop, children with FS had a slower reaction time (Mean=1193.83) than MCs (Mean=949.26, p = 0.022) for seizure symptom words. Children with FS had significantly poorer sense of control in the turbulence condition of the magic and turbulence task (Mean=-3.99, SD=8.83) than MCs (Mean=-11.51, SD=7.87; t(20)=-2.61, p =0.017). Children with FS (Mean=-1.80, SD=6.54) also had significantly poorer sense of control in the magic condition than MCs (Mean=-5.57, SD=6.01; p =0.028). Ninety-eight percent of patients endorsed premonitory symptoms.Conclusion Compared with MCs, children with FS have (1) poorer selective attention and cognitive inhibition when presented with seizure-related information and (2) lower sense of control (i.e. poorer awareness that their control was manipulated). Premonitory symptoms were common. Sense of control, selective attention, and inhibition may be novel treatment targets for FS intervention.
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Contributions from sensorimotor, emotion regulation, cognitive control, and multimodal integration brain systems to FS neuropathophysiology have been identified and constitute potential targets for treatment.
“The neuropathophysiology of FS is still uncertain, but contributions from sensorimotor, 1,2 emotion regulation, 2,3 cognitive control, 4 and multimodal integration brain systems have been identified, and constitute potential targets for treatment.”
From White Matter Changes after Neurobehavioral Therapy for Functional Seizures (2023) · cites this paper as [4]
Citation 4 is attached to the cognitive-control part of the sentence. The Conclusions report impaired cognitive inhibition, selective attention, and sense of control in children with FS and identify them as potential intervention targets. The study used behavioral measures, however, and the Discussion calls for future fMRI or other biological measures; it does not establish a contribution from a cognitive-control brain system to FS neuropathophysiology. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn a laboratory-based setting, children with functional seizures (n = 26) were characterized by a low sense of control over symptoms and by an increased attention to illness-related stimuli.
“In a laboratory-based setting, Stager and colleagues used a modified Stroop Task and the Magic and Turbulence Task to show that children with functional seizures (n = 26) were characterized by a low sense of control over symptoms and by an increased attention to illness-related stimuli [69].”
From Illness-Promoting Psychological Processes in Children and Adolescents with Functional Neurological Disorder (2023) · cites this paper as [69]
The Methods and Results describe a laboratory study of 26 children with functional seizures using the modified Stroop and Magic and Turbulence tasks. The Discussion reports poorer inhibition of attention to seizure-symptom words and less accurate judgments when control was manipulated. It does not establish low control over symptoms themselves; moreover, usable task data came from 23 and 21 children with functional seizures, respectively, rather than all 26. (LLM, conf=0.87)
Experimental — accuracy not yet measuredRetraining and control therapy (ReACT) draws on habit reversal and mindfulness to develop competing responses to functional seizure symptoms and catastrophic thoughts and symptom expectations.
“A CBT intervention developed by Aaron Fobian and colleagues for the treatment of functional seizures—termed retraining and control therapy (ReACT)—draws on habit reversal and mindfulness to develop competing responses to functional seizure symptoms and catastrophic thoughts and symptom expectations [67,69,70,71].”
From Illness-Promoting Psychological Processes in Children and Adolescents with Functional Neurological Disorder (2023) · cites this paper as [69]
The Discussion (page unavailable) describes ReACT as a cognitive-behaviorally based treatment in which patients use opposing responses to prevent or stop functional seizure symptoms and reduce catastrophic symptom expectations. It does not say that ReACT draws on mindfulness, and its separate mention of habit reversal does not establish that habit reversal is a basis for ReACT. It also does not specifically describe competing responses to catastrophic thoughts. (LLM, conf=0.86)
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References 60 · Cited by 21
- Authors
- Stager, L., Morriss, S., McKibben, L., Grant, M., Szaflarski, J. P., & Fobian, A. D.
- Affiliations
- University of Alabama at Birmingham (US)
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Fobian, Aaron D.
- Venue
- Seizure
- Publisher
- Elsevier BV
- Published
- 2022-05
- Volume
- 98
- Pages
- 79-86
- ISSN
- 1059-1311 (ISSN-L)
- PMC
- PMC9081274
- OpenAlex
- W4221092285
- Cited by
- 21
- References
- 60
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 4 · 2023: 8 · 2022: 2
- FWCI
- 3.10
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Seizure (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (1K23DK106570)
- U.S. Department of Defense (EP160028)
- National Institute of Mental Health (R61MH127155)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Keywords
- perceived control, selective attention, cognitive inhibition, premonitory symptoms, Stroop task, treatment goals
- MeSH terms
- Adolescent, Attention, Child, Cognition, Seizures, Febrile, Female, Humans, Internal-External Control, Male, Seizures, Case-Control Studies
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