Abstracts

Rationale: Functional seizures can have a range of presentations, including paroxysmal alterations in consciousness, motor activity, and sensations (i.e., smells, tastes, visual changes, and/or tingling). These are present with psychological underpinnings that are not associated with epileptiform discharges seen on electroencephalogram (EEG). Functional seizures are estimated to have a prevalence between 2-33 people per 100,000. They are also estimated to be about three times more common in women. People with functional seizures have relatively higher rates of depression, anxiety, and personality disorders compared to the general population and people with epilepsy. The use of video-EEG (VEEG) monitoring is integral in the diagnosis of functional seizures and further semiology classification. The semiology of functional seizures remains as an area of focus for aiding clinicians in distinguishing between epileptic seizures and functional seizures. Evaluating and establishing the semiological differences between the genders for functional seizures will provide further assistance. The aim of this study was to investigate the potential gender-related differences in functional seizure semiology.

Methods: Patients diagnosed with functional seizures following VEEG  monitoring, between September 2014 and December 2018, were included in this retrospective study. All the selected patients’ medical records and VEEGs were reviewed, including the semiological characteristics for each documented functional event. Each functional seizure was classified into hypomotor, hypermotor, or altered sensorium. The functional seizure semiologic characteristics evaluated were eyes open/closed, pelvic thrusting, back arching, moaning, and weeping. The demographic and semiologic features were compared between male and female patients. Chi-square and t-test were used for statistical analyses and a p-value less than 0.05 was considered statistically significant.

Results: One hundred thirty-nine patients (40 males and 99 females) between the ages of 16-81 years (mean 39.95 years) were included in the study. Demographics of patients are shown in Table 1. There were more women in the study that were single, divorced, or widowed than men (p=0.017). Women were more likely to have a mood disorder than men (p=0.024). There was a total of 490 functional events evaluated for the patients selected for the study. There was no major difference in major semiologic classification (hypomotor, hypermotor, or altered sensorium) between men and women. Out of the semiologic characteristics evaluated, weeping was more common in women than men (p=0.006) (Table 2).

Conclusions: In this study, there was one gender-related semiologic difference between the genders diagnosed with functional seizures: Weeping was significantly more related to the female gender. This finding stresses that despite possible differences in underlying etiology of functional seizures in men and women, there are no major differences between the semiology in these 2 groups, and also emphasizes the importance of discussing semiological characteristics for assistance in diagnosis of functional seizures.

Funding: None