Exploring psychedelic-assisted therapy in the treatment of functional seizures: A review of underlying mechanisms and associated brain networks
This review synthesises empirical findings and mechanistic frameworks to argue that psychedelic‑assisted therapy could be a promising treatment for functional seizures and that FS provide a well‑defined cohort to probe PAT’s large‑scale neural effects. Using a complexity‑science perspective, the authors propose an analytic roadmap to identify diagnostic specificity and treatment markers and advocate bridging clinical neurology with psychedelic medicine.
Authors
- Manesh Girn
- Elena Argento
Published
Abstract
Functional seizures (FS), the most common subtype of functional neurological disorder (FND), cause serious neurological disability and significantly impact quality of life. Characterized by episodic disturbances of functioning that resemble epileptic seizures, FS coincide with multiple comorbidities and are treated poorly by existing approaches. Novel treatment approaches are sorely needed. Notably, mounting evidence supports the safety and efficacy of psychedelic-assisted therapy (PAT) for several psychiatric conditions, motivating investigations into whether this efficacy also extends to neurological disorders. Here, we synthesize past empirical findings and frameworks to construct a biopsychosocial mechanistic argument for the potential of PAT as a treatment for FS. In doing so, we highlight FS as a well-defined cohort to further understand the large-scale neural mechanisms underpinning PAT. Our synthesis is guided by a complexity science perspective which we contend can afford unique mechanistic insight into both FS and PAT, as well as help bridge these two domains. We also leverage this perspective to propose a novel analytic roadmap to identify markers of FS diagnostic specificity and treatment success. This endeavor continues the effort to bridge clinical neurology with psychedelic medicine and helps pave the way for a new field of psychedelic neurology.
Research Summary of 'Exploring psychedelic-assisted therapy in the treatment of functional seizures: A review of underlying mechanisms and associated brain networks'
Introduction
Functional seizures (FS) are a common and disabling subtype of functional neurological disorder (FND) that produce episodic disturbances resembling epileptic seizures, yet are distinct in mechanism and treatment response. Lewis and colleagues highlight the substantial clinical and economic burden of FS, noting elevated rates of post-traumatic stress disorder, anxiety and depression in this population, predominance among women (approximately 75%), and recent incidence and prevalence estimates of 3.1/100,000 and 23.8/100,000 per year, respectively. Current care is hampered by inconsistent diagnosis, delayed or incorrect treatment (including inappropriate antiseizure medications), and limited availability and evidence for first-line psychological therapies such as CBT-informed psychotherapy. Neuroimaging to date has revealed multifocal abnormalities across large-scale networks subserving emotion, attention, interoception, self-agency and motor control, but findings are heterogeneous and have not produced a unified mechanistic account. Motivated by the growing evidence base for psychedelic-assisted therapy (PAT) in several psychiatric conditions, the paper synthesises empirical findings and theoretical frameworks to build a biopsychosocial mechanistic argument for PAT as a potential treatment for FS. The authors adopt a broad definition of psychedelics that includes classic serotonergic compounds (e.g. LSD, psilocybin, DMT/ayahuasca), ketamine, and MDMA, and draw links between these drugs' molecular and large-scale neural effects and the hypothesised pathophysiology of FS. They further propose that FS constitute a clinically well-defined cohort in which to study PAT’s neural mechanisms, and suggest applying a complexity science perspective to reconcile heterogeneous neuroimaging results and to identify candidate biomarkers and analytic strategies for future trials.
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Study Details
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- APA Citation
Lewis, E. C., Jaeger, A., Girn, M., Omene, E., Brendle, M., & Argento, E. (2024). Exploring psychedelic-assisted therapy in the treatment of functional seizures: A review of underlying mechanisms and associated brain networks. Journal of Psychopharmacology, 38(5), 407-416. https://doi.org/10.1177/02698811241248395
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