Functional seizures are associated with cerebrovascular disease and functional stroke is more common in patients with functional seizures than epileptic seizures

Purpose: To characterize the relationship between functional seizures (FSe), cerebrovascular disease (CVD), and functional stroke. Method: A retrospective case-control study of 189 patients at a single large tertiary medical center. We performed a manual chart review of medical records of patients with FSe or epileptic seizures (ES), who also had ICD code evidence of CVD. The clinical characteristics of FSe, ES, CVD, and functional stroke were recorded. Logistic regression and Welch's t-tests were used to evaluate the differences between the FSe and ES groups. Results: Cerebrovascular disease was confirmed in 58.7% and 87.6% of patients with FSe or ES through manual chart review. Stroke was significantly more common in patients with ES (76.29%) than FSe (43.48%) (p = 4.07 x 10-6). However, compared to nonepileptic controls FSe was associated with both CVD (p < 0.0019) and stroke (p < 6.62 x 10-10). Functional stroke was significantly more common in patients with FSe (39.13%) than patients with ES (4.12%) (p = 4.47 x 10-9). Compared to patients with ES, patients with FSe were younger (p = 0.00022), more likely to be female (p = 0.00040), and more likely to have comorbid mental health needs including anxiety (p = 1.06 x 10-6), PTSD or history of trauma (e.g., sexual abuse) (p = 1.06 x 10-13), and bipolar disorder (p = 0.0011). Conclusion: Our results confirm the initial observation of increased CVD in patients with FSe and further suggest that patients with FSe may be predisposed to developing another functional neurological disorder (FND) (i.e., functional stroke). We speculate that this may be due to shared risk factors and pathophysiological processes that are common to various manifestations of FND. (c) 2022 Elsevier Inc. All rights reserved.

Automated summary

This study investigates the relationship between functional seizures (FSe), cerebrovascular disease (CVD), and functional stroke. The results show that stroke is more common in patients with epileptic seizures (ES) compared to those with FSe. However, FSe is associated with both CVD and stroke when compared to nonepileptic controls. Functional stroke is more common in patients with FSe than in those with ES. Patients with FSe are also younger, more likely to be female, and more likely to have comorbid mental health needs including anxiety, PTSD or history of trauma, and bipolar disorder.