PMID- 33372972 OWN - NLM STAT- MEDLINE DCOM- 20210127 LR - 20240330 IS - 2574-3805 (Electronic) IS - 2574-3805 (Linking) VI - 3 IP - 12 DP - 2020 Dec 1 TI - Epidemiology of Functional Seizures Among Adults Treated at a University Hospital. PG - e2027920 LID - 10.1001/jamanetworkopen.2020.27920 [doi] LID - e2027920 AB - IMPORTANCE: Functional seizures (formerly psychogenic nonepileptic seizures), paroxysmal episodes that are often similar to epileptic seizures in their clinical presentation and display no aberrant brain electrical patterns, are understudied. Patients experience a long diagnostic delay, few treatment modalities, a high rate of comorbidities, and significant stigma due to the lack of knowledge about functional seizures. OBJECTIVE: To characterize the clinical epidemiology of a population of patients with functional seizures observed at Vanderbilt University Medical Center (VUMC). DESIGN, SETTING, AND PARTICIPANTS: This case-control study included patients with functional seizures identified in the VUMC electronic health record (VUMC-EHR) system from October 1989 to October 2018. Patients with epilepsy were excluded from the study and all remaining patients in the VUMC medical center system were used as controls. In total, the study included 1431 patients diagnosed with functional seizures, 2251 with epilepsy and functional seizures, 4715 with epilepsy without functional seizures, and 502 200 control patients who received treatment at VUMC for a minimum of a 3 years. Data were analyzed from November 2018 to March 2020. EXPOSURE: Diagnosis of functional seizures, as identified from the VUMC-EHR system by an automated phenotyping algorithm that incorporated International Classification of Diseases, Ninth Revision (ICD-9) codes, International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes, Current Procedural Terminology codes, and natural language processing. MAIN OUTCOMES AND MEASURES: Associations of functional seizures with comorbidities and risk factors, measured in odds ratios (ORs). RESULTS: Of 2 346 808 total patients in the VUMC-EHR aged 18 years or older, 3341 patients with functional seizures were identified (period prevalence, 0.14%), 1062 (74.2%) of whom were women and for which the median (interquartile range) age was 49.3 (39.4-59.9) years. This assessment replicated previously reported associations with psychiatric disorders including posttraumatic stress disorder (PTSD) (OR, 1.22; 95% CI, 1.21-1.24; P < 3.02 x 10-5), anxiety (OR, 1.14; 95% CI, 1.13-1.15; P < 3.02 x 10-5), and depression (OR, 1.14; 95% CI, 1.13-1.15; P < 3.02 x 10-5), and identified novel associations with cerebrovascular disease (OR, 1.08; 95% CI, 1.06-1.09; P < 3.02 x 10-5). An association was found between functional seizures and the known risk factor sexual assault trauma (OR, 10.26; 95% CI, 10.09-10.44; P < 3.02 x 10-5), and sexual assault trauma was found to mediate nearly a quarter of the association between female sex and functional seizures in the VUMC-EHR. CONCLUSIONS AND RELEVANCE: This case-control study found evidence to support previously reported associations, discovered new associations between functional seizures and PTSD, anxiety, and depression. An association between cerebrovascular disease and functional seizures was also found. Results suggested that sexual trauma may be a mediating factor in the association between female sex and functional seizures. FAU - Goleva, Slavina B AU - Goleva SB AD - Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. AD - Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee. AD - Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, Tennessee. FAU - Lake, Allison M AU - Lake AM AD - Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. AD - Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee. FAU - Torstenson, Eric S AU - Torstenson ES AD - Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee. AD - Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. AD - Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee. FAU - Haas, Kevin F AU - Haas KF AD - Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee. FAU - Davis, Lea K AU - Davis LK AD - Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. AD - Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee. AD - Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, Tennessee. LA - eng GR - R01 NS102371/NS/NINDS NIH HHS/United States GR - UL1 RR024975/RR/NCRR NIH HHS/United States GR - R01 MH118233/MH/NIMH NIH HHS/United States GR - U54 MD010722/MD/NIMHD NIH HHS/United States GR - T32 GM007347/GM/NIGMS NIH HHS/United States GR - R01 MH113362/MH/NIMH NIH HHS/United States GR - U01 HG009086/HG/NHGRI NIH HHS/United States GR - RM1 HG009034/HG/NHGRI NIH HHS/United States GR - R21 HG010652/HG/NHGRI NIH HHS/United States GR - R01 NS105746/NS/NINDS NIH HHS/United States GR - R56 MH120736/MH/NIMH NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20201201 PL - United States TA - JAMA Netw Open JT - JAMA network open JID - 101729235 SB - IM MH - Adult MH - Anxiety/epidemiology MH - Case-Control Studies MH - Comorbidity MH - Delayed Diagnosis MH - Depression/epidemiology MH - Female MH - Hospitals, University/statistics & numerical data MH - Humans MH - Male MH - Mental Disorders/*epidemiology MH - Middle Aged MH - Odds Ratio MH - Risk Factors MH - Seizures/*epidemiology/etiology/psychology MH - Stress Disorders, Post-Traumatic/epidemiology PMC - PMC7772716 COIS- Conflict of Interest Disclosures: Dr Davis reported grants from the National Institutes of Health during the conduct of the study. No other disclosures were reported. EDAT- 2020/12/30 06:00 MHDA- 2021/01/28 06:00 PMCR- 2020/12/29 CRDT- 2020/12/29 12:09 PHST- 2020/12/29 12:09 [entrez] PHST- 2020/12/30 06:00 [pubmed] PHST- 2021/01/28 06:00 [medline] PHST- 2020/12/29 00:00 [pmc-release] AID - 2774486 [pii] AID - zoi200894 [pii] AID - 10.1001/jamanetworkopen.2020.27920 [doi] PST - epublish SO - JAMA Netw Open. 2020 Dec 1;3(12):e2027920. doi: 10.1001/jamanetworkopen.2020.27920.