Ictal Injuries in Patients with Non-epileptic Seizures (NES)
Abstract number :
3.272
Submission category :
6. Cormorbidity (Somatic and Psychiatric)
Year :
2022
Submission ID :
2204936
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:27 AM
Authors :
Lyndsey Babcock, MD – University of Colorado; Stefan Sillau, PhD – Statistician, Neurology, University of Colorado; Laura Strom, MD – Medical Director - NES Clinic, Neurology, University of Colorado; Meagan Watson, MPH – NES Program Manager, Neurology, University of Colorado
Rationale: Ictal injuries attributed to epileptic seizures are common [1] but less often reported with NES [2]. NES are a non-volitional experience, yet providers largely believe that this psychological condition makes injury less likely.[3] This assumption stigmatizes patients. Having a better understanding of the injuries associated with NES is expected to guide diagnosis, treatment, and safety planning in functional neurologic disorders. The purpose here was to investigate the incidence, spectrum, and severity of ictal injuries in the University of Colorado NES patient cohort investigating possible correlations with disability, injury severity and seizure semiology.
Methods: A comprehensive literature review of NES and ictal injuries yielded 27 relevant articles. Retrospective chart review of 379 total patients, seen consecutively from 1/1/2018 -11/30/2020 was completed. Patient demographics, seizure semiology, seizure capture, documented injuries, diagnosis date, disability status, and coexisting epilepsy were collated. Injury severity was classified as mild or severe based on Centers for Disease Control and Prevention classification system. Summary statistics were prepared: frequencies and percentages for categorical variables and means tables for continuous variables. Associations with disability status and coexisting epilepsy were tested with Chi-square/Fisher’s exact test and T-tests used for categorical and continuous outcomes, respectively. Data were analyzed on an available case basis.
Results: A total of 379 NES patients were aged 18.2-74.2 (mean 37.9, sd 13.2), female (75.99%), Caucasian (84.97%). 200 patients were documented as having ictal injuries, 62.50% of 320 with available data. Injuries ranged from minor bruising to severe injury with fractures. Of 196 patients with documented ictal injury and severity data, 39 (19.90%) were rated as severe as opposed to mild. Injuries seen in patients with dual diagnosis are not attributed to their epilepsy as the proportion of dual diagnosis patients with reported injuries (48.53%) were less than for patients with NES only (65.65%) (p value = 0.0107) (Table 1). Applying for or having disability, was positively associated with having ictal injuries (69.44% vs 53.28%, p value = 0.0043).
Conclusions: The incidence of NES-ictal injuries mirrors the incidence in patients with epilepsy. NES patients exhibit a wide spectrum of injuries. The relationship of disability status to injury requires further investigation. We expect future analysis of our seizure semiology data will shed light on this subject. We anticipate that fully characterizing severity of injury will highlight the morbidity associated with NES and would be potentially destigmatizing.
References:
1. Mahler B, et al., Risk for injuries and accidents in epilepsy: A prospective population-based cohort study. Neurology. 2018;90(9):e779-e789.
2. Asadi-Pooya AA, M Farazdaghi. Ictal injury: epilepsy vs. functional seizures. Epilepsy Behav. 2021; 116:107727.
3. Rawlings GH, M Reuber. Health care practitioners’ perceptions of psychogenic nonepileptic seizures: a systematic review of qualitative and quantitative studies. Epilepsia. 2018;59(6):1109-1123.
Funding: Not applicable
Cormorbidity (Somatic and Psychiatric)