Authors :
Presenting Author: Vanessa Lee, MD – Montefiore Medical Center
Victor Ferastraoaru, MD – Montefiore Medical Center
Sheryl Haut, MD – Montefiore Medical Center, Albert Einstein Center, Albert Einstein College of Medicine, Bronx, NY, United States
Jonathan Gursky, MD – Montefiore Medical Center
Rationale:
Epilepsy is comorbid in 10-30% of patients with functional neurological disorder (FND) with functional seizures (FS) (1). Correlations between epileptic seizures (ES), FS, and anxiety and mood disorders suggest that ES and FS are closely intertwined (2,3). However, the clinical and neurobiological basis of this is not well-understood. In this study, we aim to add to the understanding of comorbid ES and FS by evaluating the relationship between changes in ES frequency and FS frequency in patients with the dual diagnosis.
- Chen DK, LaFrance WC Jr. Diagnosis and Treatment of Nonepileptic Seizures. Continuum (Minneap Minn). 2016;22(1 Epilepsy):116-131.
- Goldstein LH, Vitoratou S, Stone J, et al. Performance of the GAD-7 in adults with dissociative seizures. Seizure. 2023;104:15-21.
- Weiss A, Canetti L, David SB, Reuveni I, Ekstein D. Seizure phobia: A distinct psychiatric disorder among people with epilepsy. Seizure. 2022;95:26-32.
Methods:
A retrospective observational study was conducted at Montefiore Medical Center from 2015-2025. Patients were identified from our electronic medical record using the following inclusion criteria: 1) longitudinal care by an epileptologist, 2) ES and clinically established or documented FS, and 3) ES and FS episodes were distinguishable. Frequency of ES and FS were determined to be improved, worsened, or unchanged at consecutive clinic encounters. Statistical analysis was conducted to assess the interaction between changes in ES and FS frequency.
Results:
A total of 52 patients were included in this study. The median age was 41 years (8-86, 23.5) and 94.2% were female. Eighty point eight percent of our population had focal epilepsy, and interictal EEG and MRI abnormalities were found in 69.2% and 65.4%, respectively. The median delay in FS diagnosis was 6 years (-11-50, 13) and 59.6% of patients had a known primary psychiatric diagnosis. Seizure frequency data was gathered from 244 clinic encounters. We found that when ES frequency improved, it was more likely that FS frequency also improved (62%, p < 0.001). There was no significant relationship between change in ES or FS frequency and the number of ASM prescribed, presence of a primary psychiatric diagnosis, or active pharmacologic psychiatric treatment.