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Meta-Analysis
. 2023 Nov;64(11):3082-3098.
doi: 10.1111/epi.17752. Epub 2023 Sep 11.

Prevalence of ictal injuries in functional (psychogenic nonepileptic) seizures: A systematic review and meta-analysis

Adriana Boschi Moreira  1 , André Enoch Knochenhauer  1 , Giullia Victória Froehner  1 , Marcelo Liborio Schwarzbold  1 , Ali Akbar Asadi-Pooya  2   3 , Izabel Galhardo Demarchi  1 , Francesco Brigo  4   5 , Katia Lin  1
Affiliations
Meta-Analysis

Prevalence of ictal injuries in functional (psychogenic nonepileptic) seizures: A systematic review and meta-analysis

Adriana Boschi Moreira et al. Epilepsia. 2023 Nov.

Abstract

Objective: Ictal injuries have long been considered typical signs of epileptic seizures. However, studies have shown that patients with functional seizures (FS)-also named psychogenic nonepileptic seizures-can also present these signs, misleading physicians and delaying a correct diagnosis. This systematic review aimed to assess the prevalence of injuries from FS.

Methods: A literature search was performed in PubMed, Embase, LILACS (Latin American and Caribbean Health Sciences Literature), Scopus, Web of Science, PsycINFO, Google Scholar, OpenGrey, and ProQuest. Observational studies were included. The risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist for studies reporting prevalence data. RStudio was used for meta-analyses. Cumulative evidence was evaluated according to Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria.

Results: From the 2607 identified records, 41 studies were included in the qualitative synthesis, and 28 were included in meta-analyses. A meta-analysis of 13 studies, including 1673 individuals, resulted in an overall lifetime prevalence of injuries due to FS per person of 25% (95% confidence interval [CI] = 19%-32%, I2 = 88%). Considering a limited period (video-electroencephalographic [VEEG] monitoring days), a meta-analysis of 13 studies, including 848 individuals, resulted in an injury prevalence due to FS per person of .7% (95% CI = 0%-3%, I2 = 73%). Also, a meta-analysis of eight studies, including 1000 individuals, resulted in a prevalence of injuries per FS of .1% (95% CI = 0%-.98%, I2 = 49%). The certainty in cumulative evidence assessed by GRADE was rated "very low" for lifetime prevalence of injuries per person, "low" for prevalence per person during VEEG monitoring, and "moderate" for prevalence per number of FS.

Significance: Overall pooled lifetime prevalence of injuries due to FS per person was 25%. In comparison, the prevalence of injuries per person during VEEG monitoring and per functional seizure was .7% and .1%, respectively. [Correction added on 07 October 2023, after first online publication: In the preceding sentence, 'consecutively' was corrected to 'respectively'.] The evidence of the occurrence of injuries due to FS breaks the paradigm that epileptic seizures can cause injuries but FS cannot.

Keywords: adverse events; conversion disorder; dissociative neurological symptom disorder; dissociative seizures; wounds.

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References

REFERENCES

    1. Hallett M, Aybek S, Dworetzky BA, McWhirter L, Staab JP, Stone J. Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol. 2022;21(6):537-550.
    1. Asadi-Pooya AA, Brigo F, Mildon B, Nicholson TR. Terminology for psychogenic nonepileptic seizures: making the case for “functional seizures”. Epilepsy Behav. 2020;104(Part A):106895.
    1. International League Against Epilepsy. Epilepsy imitators: non-epileptic seizures [Internet]. Epilepsy Diagnosis: Diagnostic Manual. 2022; Available from https://www.epilepsydiagnosis.org/epilepsy-imitators.html#psychogenic
    1. Timary P, Fouchet P, Sylin M, Indriets J, de Barsy T, Lefèbvre A, et al. Non-epileptic seizures: delayed diagnosis in patients presenting with electroencephalographic (EEG) or clinical signs of epileptic seizures. Seizure. 2002;11(3):193-197.
    1. Brigo F, Storti M, Lochner P, Tezzon F, Fiaschi A, Bongiovanni LG, et al. Tongue biting in epileptic seizures and psychogenic events. An evidence-based perspective. Epilepsy Behav. 2012;25(2):251-255.

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