Abstracts

Rationale: The focus of this study is to provide an analysis of clinical characteristics (age, sex, use of psychotropic medications and use of antiseizure medication) of patients with Functional/dissociative Seizures (FDS) from our videoelectroencephalography (VEEG) unit. FDS are episodes that may resemble epileptic seizures, but lack abnormal brain electrical activity. VEEG is required to distinguish these types of events and to target proper treatment.


Methods: We retrospectively analyzed medical and VEEG records of patients with at least one functional event documented. Comparative analyses were carried out to identify significant differences between patients diagnosed with FDS and concomitant epilepsy from those with FDS and no concomitant epilepsy. Patients with structural etiology or documented epileptic events were considered as with epilepsy. For this comparison, the Mann-Whitney Tests were performed (for the two-by-two comparisons between the obtained medians), Chi-square test (Monte Carlo simulation) and Fisher's Exact Test. The differences obtained were considered statistically significant when p-value< 0.05. Statistical analyzes were performed using the Stata® program.


Results: In the period from 2020 to 2023, 828 patients were evaluated at the VEEG unit. Among these, 11.35% (n=94) documented FDS. Patients diagnosed with FDS had a median age of 31 years, with the age group from 20 to 59 years (adults) and females being the most frequent (81.91% and 77.66%, respectively). The use of antiseizure medication (ASM) and psychotropic drugs was recorded in most of the FDS patients (94.68% using ASM and 65.59% using psychotropic drugs). Concomitant epilepsy was detected in 48.94% of FDS patients.



In order to identify possible significant differences between patients diagnosed with FDS and its relationship with epilepsy, the individuals in this study were subdivided into two groups: patients with concomitant epilepsy (n=46), and patients who did not present epilepsy (n=48). No significant differences were observed in relation to age group and sex of patients. Considering the use of ASM, the data obtained indicated that the rate of FDS patients and concomitant epilepsy, and who used ASM, were statistically superior compared to that observed in patients without epilepsy (100% versus 89.58%, respectively). Furthermore, the amount of ASM was also considered significant among patients with epilepsy (median 3 versus median 1). Regarding the use and quantity of psychotropic drugs, there was no statistical significance.


Conclusions: In a nutshell, our study proves that VEEG is essential to diagnosis. Despite the use of ASM being superior in patients with epilepsy, there is still a considerable amount of patients without epilepsy using ASM. Prescribed drugs aren't the only alternative for FDS management as psychological therapy may improve the quality of life for these patients. However, access to therapy is limited in Brazil. Therefore, expertise for physicians who diagnose and manage these disorders is needed.


References

Continuum (Minneap Minn) 2019;25(2, Epilepsy):492–507.


Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.