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Symposia
Adult- Health Psychology / Behavioral Medicine
Wesley Kerr, M.D., Ph.D.
Assistant Professor of Neurology and Bioinformatics
Department of Neurology, University of Pittsburgh
Ann Arbor, MI, United States
Katherine McFarlane, MS
Health Data Analyst II
University of Pittsburgh School of Medicine
Pittsburgh, PA, United States
Alex Israel, MD
Assistant Professor of Psychiatry
University of Pittsburgh School of Medicine
Pittsburgh, PA, United States
Danielle Carns, PsyD
Assistant Professor of Neurology
University of Pittsburgh School of Medicine
Pittsburgh, PA, United States
Lianne Vighetti, MSW
Licensed Clinical Social Worker
University of Pittsburgh School of Medicine
Pittsburgh, PA, United States
Stephen Koscumbs, BS
Senior Director, Data Analytics & Knowledge Management
University of Pittsburgh School of Medicine
Pittsburgh, PA, United States
Zongqi Xia, MD, PhD
Associate Professor of Neurology, Biomedical Informatics, Clinical & Translational Science
University of Pittsburgh School of Medicine
Pittsburgh, PA, United States
Functional seizures (FS) are disabling paroxysmal neurological
symptoms that, most commonly, are associated with acute and chronic
biopsychosocial stressors and are otherwise known as psychogenic nonepileptic
seizures (PNES). Often, FS are initially diagnosed as epileptic seizures (ES). Due to
the well-established excess mortality in ES from Sudden Unexpected Death in
Epilepsy (SUDEP) and other causes, there is a perception that accurately identifying
FS is “good news,” in part, because of reduced mortality risk. However, there is
emerging evidence for similar excess mortality in FS. In this study, we used
electronic health records from a large healthcare system to directly compare excess
mortality rates in FS and ES, while controlling for other factors that may contribute
to mortality rates. Based on electronic health records, we identified patients over 18 years old who had a clinical encounter at any location of the University of Pittsburgh Medical Center with an International Classification of Disease Codes Version 10 diagnosis of ES (G40) or FS (F44.5). For each group, we evaluated the time from initial diagnosis until last follow-up or death using Cox-Proportional Hazards analysis controlling for confounding factors as well as a standardized mortality rate (SMR). We identified 29,655 patients with ES only (53.9% female; age mean 54.5 interquartile range [IQR] 37-70) and 831 with FS only (80.0% female, age mean 41.5, IQR 29-52). The median duration of follow-up was 4.0 years (IQR 1.7- 7.2). In 140,384 patient-years of observation, there were 4,012 deaths in ES and 27 deaths in FS. The raw mortality rate was higher in ES (29.6 per 1,000 patient-years) compared to FS (10.4 per 1,000 patient-years). The SMRs for each condition were similar (ES: 2.38 [95% Confidence Interval (C): 2.31-2.46], FS: 2.37 [95% CI 1.56- 3.48]). The Cox-Proportional Hazards analysis further demonstrated a lack of a significant difference in mortality associated with FS as compared to ES (Hazard Ratio 0.73, 95% CI 0.50-1.06, p=0.10), after accounting for confounding factors. This work further demonstrates that the excess mortality associated with FS was not less than ES, when accounting for underlying differences in these populations. In comparison to ES, the lower raw mortality rate in FS was associated with differences in non-seizure factors. This demonstration of similar excess mortality in FS as compared to ES emphasizes that patients with FS also warrant treatment and other interventions aimed to reduce or prevent death.