Association between psychiatric disorders and the clinical semiology of functional seizures in patients with and without comorbid epilepsy.

OBJECTIVE

To investigate the association between the semiology of functional seizures (FS) and comorbid psychiatric disorders in patients with and without epilepsy.

METHODS

Adult patients diagnosed with FS during video-electroencephalography-monitoring at the Epilepsy Centre Frankfurt Rhine-Main between 2016 and 2024 were retrospectively identified. Functional seizures were categorized into six classes based on the classification proposed by Wadwekar. Statistical analysis was performed using Kruskal-Wallis test and multivariate ordinal regression analysis (MORA).

RESULTS

A total of 2,784 patients were screened, and 603 FS were analysed from 216 patients (75.0 % female, mean age 36.7 years, range 18.0-79.0 years). The most common form (30.5 %, n = 244) were non-motor FS of class VI, followed by class IV hyperkinetic (27.2 %, n = 164), class II paucikinetic (21.9 %, n = 132), class III pseudosyncope (5.0 %, n = 30), class I dystonic (3.2 %, n = 19), and class V axial dystonic (2.2 % n = 13). Univariate analysis revealed a significant association between class II FS and borderline personality disorder (BPD, p = 0.036), class III FS and post-traumatic stress disorder (PTSD, p = 0.041), and class IV FS with a diagnosis of depression (p = 0.014). Multivariate analysis revealed a significant association between class II FS and comorbid anxiety and panic disorder (p = 0.037), as well as with BPD (p = 0.010); further associations were found for class III FS with PTSD (p = 0.015) and with epilepsy (p = 0.015), and between class VI FS and living alone (p = 0.047). In patients with comorbid epilepsy, class II FS were significantly more frequent (p = 0.047).

SIGNIFICANCE: The semiology of FS seems to be associated with psychiatric comorbidities which may improve the understanding of individual manifestations.