A minority of patients with functional seizures have abnormalities on neuroimaging.

Electroencephalography Epilepsy Humans Magnetic Resonance Imaging Neuroimaging Positron-Emission Tomography Seizures / complications
Clinical diagnostics Conversion disorder Decision analysis Dissociative seizures Psychogenic non-epileptic seizures

Journal

Journal of the neurological sciences
ISSN: 1878-5883
Titre abrégé: J Neurol Sci
Pays: Netherlands
ID NLM: 0375403

Informations de publication

Date de publication:
15 Aug 2021
Historique:
received: 28 05 2021
revised: 12 06 2021
accepted: 16 06 2021
pubmed: 4 7 2021
medline: 13 8 2021
entrez: 3 7 2021
Statut: ppublish

Résumé

Functional seizures often are managed incorrectly as a diagnosis of exclusion. However, a significant minority of patients with functional seizures may have abnormalities on neuroimaging that typically are associated with epilepsy, leading to diagnostic confusion. We evaluated the rate of epilepsy-associated findings on MRI, FDG-PET, and CT in patients with functional seizures. We studied radiologists' reports from neuroimages at our comprehensive epilepsy center from a consecutive series of patients diagnosed with functional seizures without comorbid epilepsy from 2006 to 2019. We summarized the MRI, FDG-PET, and CT results as follows: within normal limits, incidental findings, unrelated findings, non-specific abnormalities, post-operative study, epilepsy risk factors (ERF), borderline epilepsy-associated findings (EAF), and definitive EAF. Of the 256 MRIs, 23% demonstrated ERF (5%), borderline EAF (8%), or definitive EAF (10%). The most common EAF was hippocampal sclerosis, with the majority of borderline EAF comprising hippocampal atrophy without T2 hyperintensity or vice versa. Of the 87 FDG-PETs, 26% demonstrated borderline EAF (17%) or definitive EAF (8%). Epilepsy-associated findings primarily included focal hypometabolism, especially of the temporal lobes, with borderline findings including subtle or questionable hypometabolism. Of the 51 CTs, only 2% had definitive EAF. This large case series provides further evidence that, while uncommon, EAF are seen in patients with functional seizures. A significant portion of these abnormal findings are borderline. The moderately high rate of these abnormalities may represent framing bias from the indication of the study being "seizures," the relative subtlety of EAF, or effects of antiseizure medications.

Identifiants

DOI: 10.1016/j.jns.2021.117548 PMID: 34216975
pubmed: 34216975
pii: S0022-510X(21)00242-2
doi: 10.1016/j.jns.2021.117548
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

117548

Informations de copyright

Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.

Auteurs

Wesley T Kerr (WT)

Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA. Electronic address: WesleyTK@g.UCLA.edu.

John K Lee (JK)

Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Amir H Karimi (AH)

Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Hiroyuki Tatekawa (H)

Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

L Brian Hickman (LB)

Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Internal Medicine, University of California at Irvine, Irvine, CA, USA.

Michael Connerney (M)

Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Siddhika S Sreenivasan (SS)

Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Ishita Dubey (I)

Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Corinne H Allas (CH)

Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Jena M Smith (JM)

Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Ivanka Savic (I)

Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Women's and Children's Health, Karolinska Institute and Neurology Clinic, Karolinksa University Hospital, Karolinska Universitetssjukhuset, Stockholm, Sweden.

Daniel H S Silverman (DHS)

Department of Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, CA, USA.

Lubomir M Hadjiiski (LM)

Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.

Nicholas J Beimer (NJ)

Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.

William C Stacey (WC)

Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.

Mark S Cohen (MS)

Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Departments of Bioengineering, Psychology and Biomedical Physics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Jerome Engel (J)

Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA.

Jamie D Feusner (JD)

Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; Department of Women's and Children's Health, Karolinska Institute and Neurology Clinic, Karolinksa University Hospital, Karolinska Universitetssjukhuset, Stockholm, Sweden; Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.

Noriko Salamon (N)

Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

John M Stern (JM)

Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Électrodiagnostic › Électroencéphalographie › A minority of patients with functional...
questionsmedicales.fr › Maladies du système nerveux › Maladies du système nerveux central › Encéphalopathies › Épilepsie › A minority of patients with functional...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › A minority of patients with functional...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Imagerie diagnostique › Tomographie › Imagerie par résonance magnétique › A minority of patients with functional...
questionsmedicales.fr › Techniques d'investigation › Neuroimagerie › A minority of patients with functional...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Techniques de diagnostic radioisotopique › Scintigraphie › Tomoscintigraphie › Tomographie par émission de positons › A minority of patients with functional...
questionsmedicales.fr › États, signes et symptômes pathologiques › Signes et symptômes › Manifestations neurologiques › Crises épileptiques › A minority of patients with functional...