Data_Sheet_1_Case report: Improvement in refractory functional seizures, depression, and quality of life with ketamine-assisted therapy.docx

Functional seizures, a primary subtype of functional neurological disorder (FND), are a known cause of serious neurological disability with an increasing awareness of their impact amongst the neuroscience community. Situated at the intersection of neurology and psychiatry, FND is characterized by a range of alterations in motor, sensory or cognitive performance, such as abnormal movements, limb weakness, and dissociative, seizure-like episodes. Functional seizures are known, in part, to have psychological underpinnings; however, the lack of effective and consistent treatment options requires research and novel approaches to better understand the etiology, diagnosis and what constitutes a successful intervention. Ketamine, a selective blocker of the N-methyl-D-aspartate receptor, has a well-established safety and efficacy profile. In recent years, ketamine-assisted therapy has shown increasing potential for treating a broad range of psychiatric conditions, building on its demonstrated rapid-acting antidepressant effects. Here we present a 51-year-old female with refractory daily functional seizures leading to significant disability and a medical history significant for major depressive disorder (MDD) and posttraumatic stress disorder (PTSD). After unsuccessful treatment attempts, the patient underwent a novel protocol with ketamine-assisted therapy. After 3 weeks of ketamine-assisted therapy followed by 20 weeks of intermittent ketamine treatment and ongoing integrative psychotherapy, the patient’s seizures were significantly reduced in frequency and severity. She experienced significant improvements in depressive symptoms and functional ability scores. To our knowledge, this is the first reported case describing improvement in functional seizures following ketamine-assisted therapy. While rigorous studies are needed, this case report encourages further investigation of ketamine-assisted therapy for functional seizures and other functional neurological symptoms.

功能性癫痫（Functional seizures），作为功能性神经系统疾病（FND）的主要亚型，是已知导致严重神经系统功能障碍的原因，其在神经科学领域的认知度日益提高。FND位于神经病学与精神病学交汇之处，其特征为运动、感觉或认知功能出现一系列改变，例如异常运动、肢体无力以及分离性、癫痫样发作。功能性癫痫在一定程度上被认为具有心理基础；然而，缺乏有效且一致的治疗方案，亟需研究与创新方法以更深入地理解其病因、诊断以及构成成功干预的标准。氯胺酮（Ketamine），一种选择性N-甲基-D-天冬氨酸受体阻断剂，具有已证实的良好安全性和有效性。近年来，氯胺酮辅助治疗在治疗广泛的精神性疾病方面展现出越来越大的潜力，这得益于其已证实的快速起效的 antidepressant effects。在本研究中，我们介绍了一位51岁女性患者的病例，她患有难治性每日功能性癫痫，导致显著残疾，且其病史中包括重度抑郁症（MDD）和创伤后应激障碍（PTSD）。在多次治疗尝试失败后，患者接受了氯胺酮辅助治疗的新方案。经过3周的氯胺酮辅助治疗，随后20周的间歇性氯胺酮治疗以及持续的综合心理治疗，患者的癫痫发作频率和严重程度显著减少。她在抑郁症状和功能能力评分方面均取得了显著改善。据我们所知，这是首例报道在氯胺酮辅助治疗后功能性癫痫得到改善的案例。尽管需要严格的临床研究，但这一案例报告鼓励进一步研究氯胺酮辅助治疗功能性癫痫及其他功能性神经系统症状。