17 The national hospital for neurology and neurosurgeryand functional seizures: a historical perspective using a collective case analysis of archived records from 1863 to 1945

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Introduction and Aims Functional seizures (also known historically as hysterical, dissociative or psychogenic non-epileptic seizures) are seizures that look like epileptic seizures but are not associated with epileptogenic brain discharges. They are the most common form of functional neurological disorder and have been written about since Babylonian times. For the latter part of the 20th century, study into the diagnosis, mechanisms and treatment of these seizures was neglected. However, in the last 20 years, there has been a resurgence in research into functional seizures. The National Hospital for Neurology and Neurosurgery (NHNN) which opened in 1859 was the first hospital to be established in England dedicated exclusively to treating the diseases of the nervous system. The early pioneers of British and European neurology were based at the NHNN and cared for patients with functional seizures. While many of these historical figures published articles about patients with functional seizures and functional neurological disorders, the raw case files of their patients have never been systematically analysed. This project aims to conduct a qualitative analysis of the archived records of patients with functional seizures from the NHNN from 1863 to 1945. We aim to assess the approaches of these individual clinicians to patients with functional seizures, and how they evolved over time. Methods Cases of functional seizures have been identified from the Queen Square archive database using relevant search terms. The notes pertaining to these identified cases have then been retrieved and transcribed into digital records. The qualitative data within these digital records have been analysed thematically using a coding matrix, combined with additional themes that emerge from the data. Delve analytics software has been used to analyse transcribed records. Results Initial screening of the Queen Square archived database has revealed that over 350 cases of functional seizures were looked after as in-patients in the years 1863 to 1945. Using a coded qualitative analysis we have identified several themes that emerge from this review of archived cases. These themes include variability in the clinical approach and management of patients, dependent on both the neurologist in charge and contemporary knowledge of and attitudes to functional seizures (eg world- war I compared to pre-world- war I). Conclusion Analyses of the previously unseen individual case records in the Queen Square archives provide a deeper and more holistic understanding of the historical approach to patients with functional seizures.

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