Hearing voices in patients with functional seizures: Case reports and insights into mechanisms and treatments

Introduction Functional seizures (FS), paroxysmal alterations with motor, sensory, cognitive, and autonomic features without ictal epileptiform activity, are the most common subtype of functional neurological disorder (FND). FS often coexist with other symptoms, one of them being auditory hallucinations (AH); however, evidence examining this relationship is outdated and limited. The link between FND and AH has been explored, with mixed opinions on whether hallucinations should be considered part of the functional cognitive disorder. Importantly, the specific relationship between FS and AH has not been systematically examined. Methods We present 2 patients (one pediatric and one young adult) with AH and FS who underwent a 6-week multidisciplinary FND therapy program (weekly physiotherapy and psychotherapy) and experienced complete remission of AH. Results Our cases add to the limited literature on the overlap between AH and FS. Whereas prior reports have typically related AH in patients with FS to schizophrenia or other psychotic disorders, our patients did not meet the full DSM-5 diagnostic criteria for schizophrenia, and presented hallucinations without additional psychotic features. In both, hallucinations were temporally and/or contextually related to FS episodes and disappeared after a multidisciplinary FND therapy program. Conclusions Hallucinations are a nonspecific symptom of a wide range of psychiatric and nonpsychiatric conditions. The mechanisms underlying AH are multiple and remain under debate; however, AH and FND likely share common mechanisms involving disrupted self-agency and interoception, underscoring the importance of integrated therapeutic approaches over isolated psychiatric treatments.