Work

Development of a qualitative data analysis codebook for peri‐ictal behavior in suspected functional seizures

Year: 2025

Type: article

Abstract: Objective Factors that can precipitate and/or prolong functional seizure events are often challenging to identify. We aimed to develop a methodology to investigate peri‐ictal behaviors in subjects experiencing functional seizures and those around them in their home environment. Methods We conducted an iterative, four‐phase process to develop a codebook for operationalizing peri‐functional seizure behavior that involved observation of 37 functional seizures across 14 participants in the pre‐ictal, ictal, and post‐ictal phases. First, researchers reviewed and discussed the literature to devise a conceptual framework. Second, an initial codebook was drafted and refined using a test case. Third, a multi‐disciplinary panel provided feedback on the coding of three further cases to further refine code definitions. Finally, the drafted codebook was piloted on 20 functional seizure events, and a discrepancy analysis was conducted. Additional exploratory analyses were conducted with the pilot data, including a correlation analysis between the number of individuals present during pre‐ictal and ictal phases and seizure duration. Results The final codebook identifies five main factors for observers to note across the pre‐ictal, ictal, and post‐ictal phases of a functional seizure: body position, activity, behavior, nature of interaction, and number of bystanders; detailed definitions of the relevant subcodes are provided. Early exploratory analyses found that the more people present during the ictal phase, the longer the functional seizure tended to be (rs = .61, p = .004). Significance This is the first study to highlight the feasibility of investigating functional seizure peri‐ictal behavior in a home environment, offering unique benefits to capture naturalistic social factors potentially related to seizure activity. The codebook can be validated in larger datasets to improve our understanding of how peri‐ictal behavior impacts functional seizures; compare findings across studies; and inform the development of evidence‐based seizure management strategies for individuals and their carers.

Source: Epilepsia

DOI: 10.1111/epi.18491