Authors :
Presenting Author: Kazutoshi Konomatsu, MD, PhD – Tohoku University Graduate School of Medicine
Yosuke Kakisaka, MD, PhD – Tohoku University Graduate School of Medicine
Maimi Ogawa, PhD – Tohoku University Graduate School of Medicine
Mayu Fujikawa, PhD – Tohoku University Graduate School of Medicine
Takafumi Kubota, MD – Tohoku University Graduate School of Medicine
Kazushi Ukishiro, MD, PhD – Tohoku University Graduate School of Medicine
Kazutaka Jin, MD, PhD – Tohoku University Graduate School of Medicine
Rationale:
Functional dissociative seizures (FDS), also known as psychogenic nonepileptic seizures, are often misdiagnosed as epilepsy, with an average diagnostic delay of 7 years. Early diagnosis is crucial for improving long-term outcomes and reducing healthcare costs. Although several studies have identified factors linked to delays, such as young age at onset and ASM use, none have comprehensively examined the full clinical “journey.” We aimed to visualize the diagnostic timeline of FDS using the “odyssey plot” (Konomatsu K, Epilepsy Behav, 2023) and to identify factors contributing to referral delay.
Methods:
We retrospectively reviewed 50 consecutive adult patients (≥18 years) with documented FDS diagnosed at Tohoku University Hospital between 2014 and 2024. All underwent comprehensive inpatient evaluation, including video-EEG monitoring, brain MRI, and psychological assessments. The odyssey plot included four key events: FDS onset (T1), first visit to a non-epileptologist (T2), first visit to an epileptologist (T3), and first EMU admission (T4). We analyzed sex, age at onset and admission, seizure type and frequency, history of febrile seizures, comorbid epilepsy/psychiatric disorders, intellectual disability, psychological scales (NDDI-E, GAD-7, QOLIE-31P: seizure worry, overall quality of life, emotional well-being, energy/fatigue, cognitive functioning, medication effects, and social functioning), ASM use and number, education, employment, marital status, and household size. Associations with time intervals (T1–T4, T1–T2, T2–T3, T3–T4) were tested using Spearman’s correlation, Mann–Whitney U, and Kruskal–Wallis tests. p < 0.05 was considered significant.