Rationale:
Sickle Cell Disease (SCD) is associated with a higher healthcare burden in children, with a quality-adjusted life expectancy that is 30 years shorter, highlighting gaps in health care and the severity of complications. Stroke risk informs protocol and medical intervention for children with SCD presenting with neurological symptoms. We reviewed a cohort of patients with SCD who were diagnosed with functional seizures. Our goal is to describe a population with increased psychological and medical risk factors for whom the path to the diagnosis of FS may differ from their peers.
Methods:
We performed a retrospective review of patients with functional seizures at Children’s Medical Center in Dallas, Texas, with comorbid diagnoses of SCD, between 2022-2025. We described the age at FS onset and time to diagnosis, concurrent epilepsy diagnosis, history of stroke, risk factors for FS, number of images ordered, medications, and interventions as a result of FS in this population.
Results:
A total of 8 SCD patients presented with FS between 2022-2025. Of the 8 cases (3 male, 5 female), all patients identified as Black/African American, 6 had a diagnosis of Sickle Cell Disease (HgSS), 1 had HgSC, and 1 had HgS (with hematologic complications). The median age of onset of functional seizures was 11 years, with time to diagnosis ranging from immediate (< 24hr) to 1 year. Twenty-five percent of patients also carried a diagnosis of epilepsy. Three patients presented with seizure-like activity while in an active sickle cell pain crisis (37.5%). Half of patients had documentation that chronic SCD was a stressor at the time of FS presentation; other triggers included social (“bullying”, 25%). All 8 patients received Stroke Protocol imaging at least once. One patient had a history of stroke secondary to SCD; the same patient had a stroke protocol ordered 4 times since their initial presentation with FS. Half of the cases presenting with FS received an anti-seizure medication.