Factors associated with delay to video-EEG in dissociative seizures

Kerr, Wesley T.; Zhang, Xingruo; Hill, Chloé E.; Janio, Emily A.; Chau, Andrea M.; Braesch, Chelsea T.; Le, Justine M.; Hori, Jessica M.; Patel, Akash B.; Allas, Corinne H.; Karimi, Amir H.; Dubey, Ishita; Sreenivasan, Siddhika S.; Gallardo, Norma L.; Bauirjan, Janar; Hwang, Eric S.; Davis, Emily; D’Ambrosio, Shannon; Banna, Mona Al; Cho, Andrew Y.; Dewar, Sandra; Engel, Jerome; Feusner, Jamie D.; Stern, John M.

doi:10.1016/j.seizure.2021.02.018

Cited by 16 publications

(9 citation statements)

References 80 publications

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“…This type of hesitancy for referral also is seen in patients with epilepsy [116]. We did not observe a diagnostic delay from abnormal imaging, likely due to a ceiling effect because the average delay to vEEG monitoring was 9-10 years in our patients both with and without abnormal MRI.…”

Section: Discussionsupporting

confidence: 52%

A minority of patients with functional seizures have abnormalities on neuroimaging

Kerr

Lee

Karimi

et al. 2021

Journal of the Neurological Sciences

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Discussionsupporting

confidence: 52%

A minority of patients with functional seizures have abnormalities on neuroimaging

Kerr

Lee

Karimi

et al. 2021

Journal of the Neurological Sciences

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“…[3][4][5] Obstacles to successful patient outcomes with FS may arise from diagnostic and treatment delays such as availability of video-electroencephalography, lack of access to appropriate diagnosis and treatment, stigma, or lack of recognition or acceptance of the diagnosis. 6,7 Delays in diagnosis and treatment may be important determinants of patient outcomes and well-being, 8 particularly related to psychosocial difficulties and psychiatric comorbidities. 9 Whereas some studies have concluded that diagnostic delays worsen seizure outcomes in FS, [9][10][11][12][13] other reports found no such relationship.…”

Section: Introductionmentioning

confidence: 99%

Precentral gyrus and insula responses to stress vary with duration to diagnosis in functional seizures

et al. 2022

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Objective: This study was undertaken to determine whether undiagnosed illness duration (time between functional seizures [FS] onset and diagnosis) is linked to differences in neural response and functional connectivity during processing of stressful experiences.Methods: Forty-nine participants with traumatic brain injury preceding the onset of FS confirmed by video-electroencephalography were recruited prospectively. Participants completed psychiatric symptom assessments before undergoing functional magnetic resonance imaging (fMRI) with an acute psychosocial stress task. Linear mixed effects (LME) analyses identified significant interactions between the factors of group (early vs. delayed diagnosis) and time lag to diagnosis on neural responses to stressful math performance and auditory feedback (corrected α = .05). Functional connectivity analysis utilized clusters from initial LME analyses as seed regions to determine significant interactions between these factors on network functional connectivity.Results: Demographic and psychiatric symptom measures were similar between early (n = 25) and delayed (n = 24) groups. Responses to stressful math performance within the left anterior insula and functional connectivity between the anterior insula seed region and a precentral gyrus cluster were significantly negatively correlated with time lag to diagnosis for the early but not the delayed FS diagnosis group. There was no correlation between fMRI findings and psychiatric symptoms.Significance: This study indicates that aberrant left anterior insula activation and its functional connectivity to the precentral gyrus underlie differences in processing of stressful experiences in patients with delayed FS diagnosis. Follow-up comparisons suggest changes are associated with undiagnosed illness duration rather than psychiatric comorbidities and indicate a potential mechanistic association between neuropathophysiology, response to stressful experiences, and

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“…The delay to VEM for older patients with FS matched the delay to VEM for patients with medication resistant epilepsy with both being around 10-15 years [26,53]. Older patients with FS may be more difficult to identify due to higher rates of abnormal EEGs as well as medical and, particularly, cardiovascular comorbidities that may be evaluated prior to VEM [32,54].…”

Section: Kerr 15mentioning

confidence: 99%

“…Additionally, even though younger patients were referred to VEM earlier, the average delay was long [54]. Studies of treatment for FS suggested that patients who were diagnosed within 2 years of onset had better outcomes [10,59,60].…”

Section: Kerr 15mentioning

confidence: 99%

Functional seizures across the adult lifespan: female sex, delay to diagnosis and disability

Kerr

Sreenivasan

Allas

et al. 2021

Seizure

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Factors associated with delay to video-EEG in dissociative seizures

Cited by 16 publications

References 80 publications

A minority of patients with functional seizures have abnormalities on neuroimaging

A minority of patients with functional seizures have abnormalities on neuroimaging

Precentral gyrus and insula responses to stress vary with duration to diagnosis in functional seizures

Functional seizures across the adult lifespan: female sex, delay to diagnosis and disability

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