Functional seizures (FS) present substantial diagnostic and treatment challenges, particularly for Veterans with multiple medical and psychiatric comorbidities including post traumatic stress disorder, mood disorders and traumatic brain injury. To more effectively care for Veterans with FS and neuropsychiatric comorbidities, the US Department of Veterans Affairs (VA) neurology program office developed an interdisciplinary Mind Brain Program (MBP) to bridge the gap between neurology and mental health care for Veterans. In the context of expandeding MBP program development targeting Veterans with FS and complex comorbidities, this quality improvement project explored Veterans' lived experiences navigating FS diagnosis and treatment to identify opportunities for enhancing seizure care. Between April and July 2024, we conducted semi-structured interviews with 19 participants: 10 Veterans and 9 care partners. Using rapid qualitative analysis, we coded data into predefined themes to identify opportunities for improving care. Three major themes were identified within the predefined framework, with emergent subthemes. First, diagnostic challenges included clinicians' limited FS knowledge resulting in delayed video-EEG monitoring, and patient stigma, delaying diagnostic clarity. Second, limited access to specialty care was shaped by geographical barriers, lack of local expertise, scheduling difficulties, and reliance on community care referrals. Third, communication gaps within and between VA and community clinicians contributed to fragmented care, duplicated testing, and increased care partner burden. Findings are limited by a small sample from a single health system and by reliance on interview notes. Despite these limitation, findings highlight opportunities to improve FS care through standardized diagnostic pathways, enhanced clinician and patient education, strengthened communication within and between VA and community, and formal inclusion of care partners. These results can inform ongoing efforts to optimize FS care across the VA system.

Estimating premorbid cognitive capability provides a baseline to accurately identify and quantify cognitive impairments incurred following neurological illness or injury, including in epilepsy. Irregular word reading tests like the Test of Premorbid Functioning (TOPF) are routinely used for this purpose, underpinned by the assumption that they rely on aspects of cognitive capability impervious to neurological insult. Given accumulating evidence in distinct neurological populations that the TOPF is sensitive to pathology, this study investigated the TOPF as an estimate of premorbid cognitive capability in 102 temporal lobe epilepsy (TLE) patients (M = 38.70 years, SD = 13.76, 56 female) and 168 controls (M = 25.60 years, SD = 11.98, 118 female). Patient TOPF scores were significantly poorer relative to controls (g = 1.27). Rates of impairment on each cognitive measure differed significantly depending on how impairment was classified, that is, either using TOPF performance (premorbid approach) or normative data (normative approach). Among controls, the premorbid approach yielded higher impairment rates than the normative approach across all cognitive tests. Among patients, the premorbid approach yielded lower impairment rates than the normative approach on some cognitive tests. Correlations between the TOPF and other neuropsychological measures were mostly weak, ranging from r = -0.04 to r = 0.36 in controls and r = -0.03 to r = 0.53 in patients. Findings suggest that the TOPF is susceptible to TLE pathology, which violates the assumptions that underpin the use of irregular word reading as an estimate of premorbid cognitive capability in this population.