Visualizing diagnostic delays in functional/dissociative seizures using the referral odyssey plot: A retrospective...

Area of Science:

• Neurology
• Psychiatry
• Healthcare Management

Background:

• Functional/dissociative seizures (FDS) are frequently misdiagnosed as epilepsy, delaying appropriate treatment.
• Understanding the referral trajectory for FDS is crucial for improving diagnostic timelines.

Purpose of the Study:

• To visualize the diagnostic journey of patients with FDS using a novel "referral odyssey plot."
• To identify factors associated with referral delays and prolonged diagnosis of FDS.

Main Methods:

• Retrospective review of 50 patients with FDS at Tohoku University Hospital (2014-2024).
• Utilized long-term video-electroencephalogram monitoring, MRI, and psychosocial assessment.
• Defined four milestones: seizure onset, first non-epileptologist visit, first epileptologist consultation, and EMU admission.
• Analyzed diagnostic pathways and factors associated with delays using statistical methods.

Main Results:

• Median total diagnostic delay was 51 months.
• The longest delay (median 41 months) was between the first non-epileptologist visit and the first epileptologist consultation, strongly correlating with total delay.
• Younger age at onset and family history of epilepsy were linked to longer pre-epileptologist delays.

Conclusions:

• Delayed referral to an epileptologist is the primary cause of prolonged FDS diagnosis.
• The referral odyssey plot effectively visualizes patient pathways and diagnostic bottlenecks.
• Emphasizes the need for timely access to epileptologists for accurate FDS and epilepsy evaluation.