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

Abstract

ObjectiveIctal injuries have long been considered typical signs of epileptic seizures. However, studies have shown that patients with functional seizures (FS) – also named psychogenic non‐epileptic 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.MethodsA literature search was performed in PubMed, Embase, LILACS, Scopus, Web of Science, PsycINFO, Google Scholar, OpenGrey, and ProQuest. Observational studies were included. The risk of bias was assessed using the JBI checklist for studies reporting prevalence data. RStudio was used for meta‐analyses. Cumulative evidence was evaluated according to GRADE criteria.ResultsFrom the 2,607 identified records, 41 studies were included in the qualitative synthesis, and 28 were included in meta‐analyses. A meta‐analysis of 13 studies, including 1,673 individuals, resulted in an overall lifetime prevalence of injuries due to FS per person of 25% (95% CI 19%‐32%; I2 = 88%). Considering a limited period (VEEG monitoring days), a meta‐analysis of 13 studies, including 848 individuals, resulted in an injury prevalence due to FS per person of 0.7% (95% CI 0%‐3%; I2 = 73%). Also, a meta‐analysis of 8 studies, including 1,000 individuals, resulted in a prevalence of injuries per FS of 0.1% (95% CI 0%‐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.SignificanceOverall 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 0.7% and 0.1%, consecutively. The evidence of the occurrence of injuries due to FS breaks the paradigm that epileptic seizures can cause injuries, but FS cannot. Registration: PROSPERO ID# CRD42020209300