Discriminating clinical profiles in epilepsy, in functional/dissociative seizures (FDS) and co-occurrence

Context

By accurately differentiating clinical profiles, healthcare providers can offer more personalized and effective care to patients with seizure disorders, improving their overall quality of life.

Objective

This study aimed to compare the demographic, psychiatric, neurological, and trauma profiles of patients with functional/dissociative seizures (FDS), epilepsy, and the co-occurrence of FDS and epileptic seizures.

Methods

We conducted a cross-sectional study. Patients were recruited from two epileptology departments (Nancy University Hospital and La Teppe Institute, France) between 2018 and 2023. Diagnosis was made by experienced epileptologist according to the criteria of the ILAE (International League Against Epilepsy). All patients underwent a systematic psychiatric assessment including investigation of demographic, neurological, psychiatric, and trauma data through a semi-structured clinical interviews and standardized scales.

Results

We analyzed 296 patients: 195 patients with epilepsy, 66 patients with FDS, and 35 with both. The FDS-only group was more likely to be female (p=.004), have later seizure onset (p<.001), use fewer antiseizure medications (p<.001), and report sexual trauma (p<.001) and alexithymia (p<.001). Conversely, patients with epilepsy-only had fewer psychiatric comorbidities (p<.001) and past traumatic experiences (p<.001) and dissociative tendencies (p<.001). Both the FDS-only and FDS+Epilepsy groups exhibited higher rates of psychiatric comorbidities (83.3%, 74.3%) and past traumatic experiences (87.9%, 85.3%) compared to the Epilepsy-only group (43.1%, 62.1%).

Significance

Both the FDS-only and FDS+Epilepsy groups demonstrated high rates of psychiatric disorders and past traumatic experiences. Sexual trauma and late seizure onset appear to be strongly linked to a FDS diagnosis.