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

Area of Science:

• Neurology
• Psychiatry
• Clinical Medicine

Background:

• Accurate differentiation of clinical profiles in seizure disorders improves patient care and quality of life.
• Understanding distinct patient profiles is crucial for personalized treatment strategies in epilepsy and functional/dissociative seizures (FDS).

Purpose of the Study:

• To compare demographic, psychiatric, neurological, and trauma profiles of patients with FDS, epilepsy, and co-occurring FDS and epileptic seizures.
• To identify key differentiating factors between these seizure disorder classifications.

Main Methods:

• Cross-sectional study conducted in two French epileptology departments (2018-2023).
• Diagnosis by experienced epileptologists adhering to International League Against Epilepsy (ILAE) criteria.
• Systematic psychiatric assessment including semi-structured interviews and standardized scales for demographic, neurological, psychiatric, and trauma data.

Main Results:

• Analysis of 296 patients: 195 epilepsy, 66 FDS, 35 both.
• FDS-only group: more females, later seizure onset, fewer antiseizure medications, higher rates of sexual trauma and alexithymia.
• Epilepsy-only group: fewer psychiatric comorbidities, less past trauma, and fewer dissociative tendencies.
• Both FDS-only (83.3%) and FDS+Epilepsy (74.3%) groups showed higher psychiatric comorbidity and trauma rates than Epilepsy-only (43.1%).

Conclusions:

• Patients with FDS (both FDS-only and FDS+Epilepsy) exhibit significantly higher rates of psychiatric disorders and past traumatic experiences.
• Sexual trauma and later seizure onset are strongly associated with a diagnosis of functional/dissociative seizures (FDS).
• Distinguishing between epilepsy and FDS is critical for effective management and patient outcomes.