Epidemiology of Functional Seizures Among Adults Treated at a University Hospital.
Epidemiology of Functional Seizures Among Adults Treated at a University Hospital.
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DOI：
10.1001/jamanetworkopen.2020.27920
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发表时间：
2020-12-01
影响因子：
13.8
通讯作者：
Davis LK
中科院分区：
文献类型：
--
作者：
Goleva SB;Lake AM;Torstenson ES;Haas KF;Davis LK
功能性癫痫发作患者的周期患病率和合并症是多少？这项病例对照研究包括 3341 名功能性癫痫发作患者（经期患病率为 0.14%），该患者是从大学医疗中心的所有患者中筛选出来的，发现创伤后应激障碍和性侵犯创伤与功能性癫痫发作有关。发现了新的关联，包括脑血管疾病。这项研究的结果表明，出现癫痫发作和其他精神合并症、性侵犯创伤史或脑血管疾病的患者应转诊进行视频脑电图诊断评估。这项针对大型大学医疗中心患者的病例对照研究提供了功能性癫痫发作及其与合并症（例如脑血管疾病）和危险因素（例如性侵犯创伤）的关联的流行病学评估。功能性癫痫发作（以前称为心因性非癫痫发作）是一种阵发性发作，其临床表现通常与癫痫发作相似，并且没有表现出异常的脑电模式，目前尚未得到充分研究。由于缺乏对功能性癫痫发作的了解，患者会经历长时间的诊断延迟、很少的治疗方式、高合并症发生率以及明显的耻辱感。旨在描述范德比尔特大学医学中心 (VUMC) 观察到的功能性癫痫患者群体的临床流行病学特征。这项病例对照研究包括 1989 年 10 月至 2018 年 10 月在 VUMC 电子健康记录 (VUMC-EHR) 系统中识别出的功能性癫痫发作患者。癫痫患者被排除在研究之外，VUMC 医疗中心系统中的所有剩余患者都用作对照。该研究总共包括 1431 名被诊断为功能性癫痫发作的患者、2251 名患有癫痫和功能性癫痫发作的患者、4715 名患有癫痫但不伴有功能性癫痫发作的患者，以及 502-200 名在 VUMC 接受至少 3 年治疗的对照患者。分析了 2018 年 11 月至 2020 年 3 月的数据。功能性癫痫的诊断，通过自动表型分析算法从 VUMC-EHR 系统中识别，该算法结合了国际疾病分类第九修订版 (ICD-9) 代码、国际疾病和相关健康问题统计分类第十修订版 (ICD-10) 代码、当前程序术语代码和自然语言处理。功能性癫痫发作与合并症和危险因素的关联，以比值比 (OR) 衡量。在 VUMC-EHR 的 2~346~808 名 18 岁或以上患者中，发现了 3341 名功能性癫痫患者（周期患病率 0.14%），其中 1062 名（74.2%）为女性，中位年龄（四分位距）为 49.3（39.4-59.9）岁。该评估重复了之前报道的与精神疾病的关联，包括创伤后应激障碍（PTSD）（OR，1.22；95% CI，1.21-1.24；P < 3.02 × 10−5）、焦虑（OR，1.14；95% CI，1.13-1.15；P < 3.02 × 10−5） P < 3.02 × 10−5）和抑郁症（OR，1.14；95% CI，1.13-1.15；P < 3.02 × 10−5），并确定了与脑血管疾病的新关联（OR，1.08；95% CI，1.06-1.09；P < 3.02 × 10−5）。 P < 3.02 × 10−5)。功能性癫痫发作与已知危险因素性侵犯创伤之间存在关联（OR，10.26；95% CI，10.09-10.44；P < 3.02 × 10−5），并且在 VUMC-EHR 中发现性侵犯创伤介导了女性性别与功能性癫痫发作之间近四分之一的关联。这项病例对照研究发现了支持先前报道的关联的证据，发现了功能性癫痫发作与创伤后应激障碍、焦虑和抑郁之间的新关联。还发现脑血管疾病和功能性癫痫发作之间存在关联。结果表明，性创伤可能是女性性别与功能性癫痫发作之间关联的中介因素。
What is the period prevalence and comorbidity of patients with functional seizures? This case-control study including 3341 patients with functional seizures (period prevalence, 0.14%) identified from all patients at a university medical center found that posttraumatic stress disorder and sexual assault trauma were associated with functional seizures. Novel associations were identified, including cerebrovascular disease. The findings of this study suggest that patients who present with seizures and additional psychiatric comorbidities, sexual assault trauma history, or cerebrovascular disease should be referred for video electroencephalogram diagnostic assessment. This case-control study of patients at a large university medical center provides an epidemiological assessment of functional seizures and their association with comorbidities (eg, cerebrovascular disease) and risk factors (eg, sexual assault trauma). 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. To characterize the clinical epidemiology of a population of patients with functional seizures observed at Vanderbilt University Medical Center (VUMC). 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. 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. Associations of functional seizures with comorbidities and risk factors, measured in odds ratios (ORs). 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 × 10−5), anxiety (OR, 1.14; 95% CI, 1.13-1.15; P < 3.02 × 10−5), and depression (OR, 1.14; 95% CI, 1.13-1.15; P < 3.02 × 10−5), and identified novel associations with cerebrovascular disease (OR, 1.08; 95% CI, 1.06-1.09; P < 3.02 × 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 × 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. 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.
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