Risk for death among individuals with functional seizures is higher than in the general population but remains lower than that observed in epileptic seizures, according to study results published in Epilepsia.To compare mortality risk across seizure type, researchers analyzed data from the TriNetX Research Network, including individuals with functional seizures (n=32,854), epileptic seizures (n=1,916,787), and no seizure disorder (n=21,053,667). To reduce cohort differences, 32,711 patients with functional seizures were matched 1:1 with patients with epileptic seizures, and a separate cohort of 32,274 patients with functional seizures was matched 1:1 with control participants.

The functional seizure, epileptic seizure, and control cohorts comprised 24.9%, 50.6%, and 45.6% men, respectively. Mean (SD) ages were 34.7 (19.5), 40.4 (25.2), and 35.2 (25.0) years, and 58.5%, 56.7%, and 56.4% of participants were White.

 

Although the causes of death are not explained by these data, and would benefit from future elucidation, they should provide further motivation for clinicians and services to improve engagement and therapies for people with [functional seizures].

Patients with functional seizures had higher rates of most mental and physical comorbidities compared with those with epileptic seizures. The most prevalent comorbid conditions among individuals with functional seizures, compared with those with epileptic seizures, included diseases of the nervous system (37.0% vs 24.6%; P <.001); musculoskeletal and connective tissue diseases (34.4% vs 23.3%; P <.001); endocrine, nutritional, and metabolic diseases (28.6% vs 24.8%; P <.001); digestive diseases (27.2% vs 20.8%; P <.001); and respiratory diseases (26.8% vs 21.3%; P <.001). Compared with control participants, individuals with functional seizures had higher rates of all measured comorbid mental and physical health conditions (all P <.001).

Mortality occurred among 1040 patients with functional seizures, 217,193 patients with epileptic seizures, and 627,756 control participants. Risk for mortality was higher among patients with epileptic seizures compared with those with functional seizures (hazard ratio [HR], 2.99; 95% CI, 2.81-3.18), and remained elevated after matching (HR, 2.07; 95% CI, 1.92-2.24). In contrast, control participants had a lower risk for mortality compared with patients with functional seizures (HR, 0.56; 95% CI, 0.53-0.59), including after matching (HR, 0.48; 95% CI, 0.44-0.53).

The lower mortality risk among control participants was most pronounced in the year following functional seizure diagnosis (HR, 0.39; 95% CI, 0.33-0.47). In age-stratified analyses of matched cohorts, the greatest disparity in mortality risk was observed among individuals aged 40 to 49 years (HR, 0.379; 95% CI, 0.274-0.525), with significantly lower risk also observed across other adult age groups.

Study limitations include incomplete mortality capture within the TriNetX database, lack of cause-specific mortality data, absence of socioeconomic variables, potential diagnostic misclassification, and differences in follow-up duration between cohorts.The study investigators concluded, “Although the causes of death are not explained by these data, and would benefit from future elucidation, they should provide further motivation for clinicians and services to improve engagement and therapies for people with [functional seizures].”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.