Telehealth ReACT improved functional seizures and broader pediatric FND symptoms
Telehealth delivery of Retraining and Control Therapy produced sustained improvement in adolescents with functional neurological disorder and functional seizures, with benefits extending beyond seizure frequency to motor, cognitive, and psychosocial domains. In a prospective observational cohort of 34 adolescents who completed treatment, most patients reported marked seizure reduction soon after therapy ended, and a substantial proportion remained seizure-free at 6 months.
The pattern is clinically meaningful because functional seizures rarely occur in isolation. Adolescents often carry overlapping motor, psychological, and cognitive symptoms that shape school attendance, family stress, and confidence in their own bodies. A treatment capable of reducing one symptom cluster while also easing the broader burden of FND has practical relevance for pediatric neurology, psychology, and rehabilitation medicine alike.
Study design and telehealth delivery across 12 sessions
Adolescents aged 11 to 18 years with functional seizures completed one in-person session followed by 11 telehealth ReACT sessions. The study tracked seizure frequency over three windows: the 30 days before treatment, the 30 days after treatment, and the 30 days assessed 6 months later. Cognitive performance was measured at baseline and 1 week after treatment, while other biopsychosocial measures and FND symptoms were collected at baseline, 1 week after treatment, and again at 6 months.
The final sample included 34 consecutively enrolled adolescents, most of them female, and the mean age was 15.4 years. Twenty-eight completed 6-month follow-up. The cohort therefore reflects a real-world adolescent FND population treated through a blended model that combined an initial face-to-face visit with predominantly remote care.
This matters because telehealth is not merely a logistical substitute. For functional neurological symptoms, repeated coaching, symptom retraining, and caregiver involvement often matter as much as geography. Remote delivery can reduce missed school time, lessen travel burden, and make therapy more accessible for families who may already be stretched by recurrent emergency visits, specialist appointments, and diagnostic uncertainty.
Seizure reduction persisted months after treatment ended
The seizure data were striking. At 30 days after treatment, 94% of adolescents reported at least a 50% reduction in functional seizures, and 62% reported complete seizure freedom. By 6 months, 87% still reported at least a 50% reduction, and 61% remained seizure-free.
Those numbers suggest durability rather than a short-lived post-treatment effect. Functional seizures are often maintained by learned threat responses, attentional loops, and reinforced avoidance behaviors. ReACT is designed to interrupt those patterns through retraining and control strategies, helping patients recognize early cues, reassert agency over symptoms, and reduce the sense that the body is acting independently of intention. When that framework works, the clinical impact can appear quickly; when it persists, the downstream benefits can be wide-ranging.
Broader FND symptoms improved across motor, negative motor, and cognitive domains
Improvements were not confined to seizure frequency. Among adolescents who had reported positive motor symptoms other than functional seizures, 60% were symptom-free at 1 week after treatment, rising to 75% by 6 months. For negative motor symptoms, 60% were symptom-free at 1 week and 70% at 6 months. For psychological and cognitive FND symptoms, 80% were symptom-free at 1 week, and every adolescent in that subgroup reported symptom freedom at 6 months.
These shifts point to a broader therapeutic effect on the functional symptom network rather than a narrow seizure-only response. Motor symptoms in FND often reflect altered predictive processing, heightened symptom monitoring, and disrupted movement control. Psychological and cognitive complaints can follow the same pattern, especially when fatigue, anxiety, and hypervigilance amplify each other. ReACT appears to reach into those linked domains, not by treating each symptom separately, but by changing how patients respond to symptom signals and regain control.
One sentence captures the clinical weight of the findings: the symptom burden did not simply soften; it kept improving after treatment ended.
Biopsychosocial gains extended beyond symptom counts
Cognitive performance and biopsychosocial outcomes improved after ReACT and remained stable or continued to improve at 6 months. The report does not rely on seizure counts alone, and that is important. Adolescents with FND often judge recovery through a wider lens: classroom concentration, fear of relapse, family conflict, physical confidence, and the ability to participate in ordinary life without constant symptom anticipation.
By tracking both cognitive and biopsychosocial endpoints, the study aligns with how FND presents in practice. Functional neurological symptoms are shaped by attention, expectation, stress physiology, and reinforcement from the social environment. When therapy helps patients reinterpret bodily sensations, reduce catastrophic interpretation, and reestablish behavioral control, improvement can ripple outward into cognition, mood, and day-to-day functioning. The maintenance of gains at 6 months suggests that these changes were not limited to the therapy room.
Why telehealth access may matter for pediatric FND care
The telehealth format is central to the clinical message. Pediatric FND care often demands consistency, family participation, and repeated practice of behavioral strategies. Remote sessions may lower barriers for families who cannot easily travel to specialty centers, particularly when symptoms disrupt school schedules or require frequent outpatient contact. In a field where access gaps are common, a remotely delivered treatment that retains benefit at 6 months deserves attention.
The study also reinforces an important principle in pediatric neurology: symptom legitimacy and symptom reversibility can coexist. Adolescents with functional seizures are not fabricating events, and improvement does not depend on proving symptoms are “all in the mind.” Rather, effective treatment targets the brain-body control systems that generate involuntary episodes and accompanying motor or cognitive complaints.
Limits of the cohort and the next clinical question
The sample was modest, lacked a randomized comparison group, and relied heavily on self-reported outcomes. The final 6-month analysis also included fewer participants than the initial treated cohort, leaving room for follow-up bias. Even so, the durability of benefit across multiple symptom domains makes the findings clinically relevant and hypothesis-generating for larger trials.
A randomized study with objective functional measures, broader demographic representation, and longer follow-up would help clarify how much of the observed benefit comes from ReACT itself, how much depends on telehealth delivery, and which adolescents are most likely to respond. For now, the study shows that telehealth ReACT can reach beyond seizure control and produce sustained improvement in the broader burden of pediatric functional neurological disorder.