Epilepsy, dissociative seizures, and mixed: Associations with time to video-EEG

Kerr, Wesley T.; Zhang, Xingruo; Hill, Chloé E.; Janio, Emily A.; Chau, Andrea M.; Braesch, Chelsea T.; Le, Justine M.; Hori, Jessica M.; Patel, Akash B.; Allas, Corinne H.; Karimi, Amir H.; Dubey, Ishita; Sreenivasan, Siddhika S.; Gallardo, Norma L.; Bauirjan, Janar; Hwang, Eric S.; Davis, Emily; D’Ambrosio, Shannon; Banna, Mona Al; Cho, Andrew Y.; Dewar, Sandra; Engel, Jerome; Feusner, Jamie D.; Stern, John M.

doi:10.1016/j.seizure.2021.02.002

Cited by 4 publications

(6 citation statements)

References 101 publications

(153 reference statements)

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“…The International League Against Epilepsy recommends referral for vEEG monitoring when patients with seizures are not seizure free after two appropriately chosen and tolerated ASMs. However, the average patient with functional seizures and ERF or EAF on MRI was currently taking 2 ASMs and had tried 1.5 ASMs in the past, suggesting a delay in referral [5,92].…”

Section: Discussionmentioning

confidence: 99%

“…We compared the correspondence between borderline or definitive EAF on MRI and PET using Cohen's kappa statistics. The association between the imaging findings and age, cardiovascular disease, prior antiseizure medications, current antiseizure medications, and delay to diagnosis was evaluated using Student's t-tests, log-normal t-tests for delay to vEEG [92], and Fisher exact tests. Patients with missing data were excluded from the relevant pairwise comparisons (complete case analysis).…”

Section: Methodsmentioning

confidence: 99%

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A minority of patients with functional seizures have abnormalities on neuroimaging

Kerr

Lee

Karimi

et al. 2021

Journal of the Neurological Sciences

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

A minority of patients with functional seizures have abnormalities on neuroimaging

Kerr

Lee

Karimi

et al. 2021

Journal of the Neurological Sciences

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“…However, in a recent evaluation of factors that contributed to time to vEEG monitoring in this data set, a history of TBI was not associated with time to referral for FS, but it was associated with longer time to vEEG in patients with epilepsy. 24 Despite delays in referral, patients with suspected PTE also may be more likely to be referred to vEEG because of hypothesized surgical candidacy. 45,46 We additionally considered what role psychiatric diagnoses may have in the relationship between FS and TBI.…”

Section: Discussionmentioning

confidence: 99%

“…Analysis of other portions of this interview has been published elsewhere. 6,[22][23][24] During patient interviews, we inquired about head injuries with open-ended questions. Based on patient/caregiver descriptions of head trauma, we graded severity using standardized definitions.…”

Section: Standardized Interviewmentioning

confidence: 99%

Self-Reported Severity and Causes of Traumatic Brain Injury in Patients With Epileptic or Functional Seizures

et al. 2022

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Abstract:Background:While moderate and severe traumatic brain injury (TBI) can cause post-traumatic epilepsy, many patients with functional seizures (FS) also report a history of mild TBI. To determine if features of TBI history differs between patients with epileptic seizures (ES) and FS, we compared patient reports of TBI severity, symptoms, and causes of injury.Methods:We recruited patients undergoing video-EEG evaluation for diagnosis of ES, FS, mixed ES and FS, or physiologic seizure-like events at an academic, tertiary referral center. Patients and their caregivers were interviewed prior to final video-EEG diagnosis regarding their TBI histories, including concussive symptoms and causes of injury.Results:Of 506 patients, a greater percentage of patients with FS reported a history of TBI than patients with ES (70% vs 59%, aOR=1.75 [95% confidence interval: 1.00-3.05], p=0.047). TBI with loss of consciousness (LOC) lasting less than 30 minutes was more frequently reported among patients with functional seizures than with ES (27% vs 13%, aOR=2.38 [1.26-4.47], p<0.01). The proportion of patients reporting other neurological symptoms immediately after TBI was not significantly different between FS and ES (40% vs 29%, p=0.08). Causes of TBI were found to differ, with TBIs caused by falls from a height (17% vs 10%, aOR=2.24 [1.06-4.70], p=0.03) or motor vehicle collisions (27% vs 11%, aOR=2.96 [1.54-5.67], p<0.01) reported more frequently in FS than ES.Discussion:Our findings further the association of mild TBI with FS and prompt reconsideration of typical assumptions regarding the significance of reported TBI history in patients with previously undifferentiated seizures. While common in both groups, TBI with LOC less than 30 minutes and causes of injury that are commonly thought to be more severe were reported more frequently in FS than ES. This suggests that patient or caregiver reporting of these features does not imply post-traumatic epilepsy is a more probable diagnosis than FS. While history of TBI with LOC and presumed high-risk causes of injury intuitively raises suspicion for post-traumatic epilepsy, clinicians should be cautioned that these historical factors also were a frequent finding in patients with FS.

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“…Long delays (median 3 years, average 8 years post-onset) can ensue until an accurate diagnosis is established through videoelectroencephalographic monitoring (VEM) [11][12][13]. In the interim, patients may have high healthcare utilization and poor quality of life, similar to or worse than patients with medicationresistant epilepsy [14][15][16][17][18][19][20][21][22][23][24]. Earlier diagnosis was associated with improved seizure control, quality of life, and substantial reductions in healthcare utilization [25].…”

Section: Introductionmentioning

confidence: 99%

Clinical MRI morphological analysis of functional seizures compared to seizure-naïve and psychiatric controls

Kerr

Tatekawa

Lee

et al. 2022

Epilepsy & Behavior

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Epilepsy, dissociative seizures, and mixed: Associations with time to video-EEG

Cited by 4 publications

References 101 publications

A minority of patients with functional seizures have abnormalities on neuroimaging

A minority of patients with functional seizures have abnormalities on neuroimaging

Self-Reported Severity and Causes of Traumatic Brain Injury in Patients With Epileptic or Functional Seizures

Clinical MRI morphological analysis of functional seizures compared to seizure-naïve and psychiatric controls

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