A minority of patients with functional seizures have abnormalities on neuroimaging

JOURNAL OF THE NEUROLOGICAL SCIENCES

卷:427

Article

Kerr, Wesley T.^1,2  Lee, John K.¹  Karimi, Amir H.¹  Tatekawa, Hiroyuki³  Hickman, L. Brian^1,4  Connerney, Michael¹  Sreenivasan, Siddhika S.¹  Dubey, Ishita¹  Allas, Corinne H.¹  Smith, Jena M.¹  Savic, Ivanka^1,5,6  Silverman, Daniel H. S.⁷  Hadjiiski, Lubomir M.⁸  Beimer, Nicholas J.^9,10  Stacey, William C.^9,11  Cohen, Mark S.^{1,2,3,12,13,14}  Engel, Jerome^1,2,15,16  Feusner, Jamie D.^{2,5,6,17,18,19}  Salamon, Noriko^1,3  Stern, John M.¹ 

[1] UCLA, David Geffen Sch Med, Dept Neurol, Los Angeles, CA 90095 USA

[2] Univ Calif Los Angeles, Dept Psychiat & Biobehav Sci, Los Angeles, CA 90024 USA

[3] UCLA, David Geffen Sch Med, Dept Radiol, Los Angeles, CA 90095 USA

[4] Univ Calif Irvine, Dept Internal Med, Irvine, CA USA

[5] Karolinska Univ Sjukhuset, Karolinksa Univ Hosp, Dept Womens & Childrens Hlth, Karolinska Inst, Stockholm, Sweden

[6] Karolinska Univ Sjukhuset, Karolinksa Univ Hosp, Neurol Clin, Stockholm, Sweden

[7] Univ Calif Los Angeles, Dept Mol & Med Pharmacol, Los Angeles, CA USA

[8] Univ Michigan, Dept Radiol, Michigan Med, Ann Arbor, MI 48109 USA

[9] Univ Michigan, Dept Neurol, Michigan Med, Ann Arbor, MI USA

[10] Univ Michigan, Dept Psychiat, Michigan Med, Ann Arbor, MI 48109 USA

[11] Univ Michigan, Dept Biomed Engn, Ann Arbor, MI 48109 USA

[12] UCLA, David Geffen Sch Med, Dept Bioengn, Los Angeles, CA 90095 USA

[13] UCLA, David Geffen Sch Med, Dept Psychol, Los Angeles, CA 90095 USA

[14] UCLA, David Geffen Sch Med, Dept Biomed Phys, Los Angeles, CA 90095 USA

[15] UCLA, David Geffen Sch Med, Dept Neurobiol, Los Angeles, CA 90095 USA

[16] Univ Calif Los Angeles, Brain Res Inst, Los Angeles, CA 90024 USA

[17] Ctr Addict & Mental Hlth, Toronto, ON, Canada

[18] Univ Toronto, Dept Psychiat, Toronto, ON, Canada

[19] Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden

关键词: Decision analysis;    Clinical diagnostics;    Psychogenic non-epileptic seizures;    Conversion disorder;    Dissociative seizures;   

DOI  :  10.1016/j.jns.2021.117548

来源: Elsevier

【 摘 要 】

Objective: 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. Methods: 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 epilepsyassociated findings (EAF), and definitive EAF. Results: 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. Significance: 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.

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