Dissociative seizures are associated with high levels of socioeconomic deprivation, according to study results published in Epilepsia. The multicenter cohort study included 698 patients, making it the largest study of adults with dissociative seizures to date.
Laura H. Goldstein, PhD, MPhil, from the Institute of Psychiatry, Psychology, and Neuroscience at King’s College London, United Kingdom, and colleagues evaluated demographic and clinical data from 698 adults (mean age, 37.1 years; 73.8% women) with dissociative seizures within the previous 8 weeks. Patients were recruited from 27 neurology and specialist epilepsy clinics in the United Kingdom between October 2014 and February 2017.
In accordance with the literature, dissociative seizures were more common in women than men. By age 40 years, 77% of women had developed dissociative seizures compared with only 59% of men. Overall, the median age at dissociative seizure onset was 28 years and the median duration of dissociative seizures was 3 years. In addition, 27% of patients self-reported a previous epilepsy diagnosis, although the reliability of these diagnoses was unclear, and 30% of the sample reported taking anti-epileptic drugs.
Patients with hypokinetic seizures (32% of the sample) had a longer duration of the disorder (P <.001) than patients with hyperkinetic seizures (68%), whose symptom onset most commonly occurred in their late teens. Gender differences were not associated with dissociative seizure type.
Of note, more than half of patients lived in areas with the highest levels of socioeconomic deprivation and more than two‐thirds were unemployed. The majority of unemployed patients who were of working age (72.9%) were dependent on state financial benefits.
The investigators noted that patients did not receive their diagnoses via video‐EEG telemetry, which is the gold standard. Also, recruiting for the study was conducted through services in urban areas, which may have influenced the study population.
“The high levels of deprivation and benefits use associated with the dissociative seizures diagnosis in this population clearly demonstrate the social and societal dimension of this disorder, which may have effects on access to diagnostic and treatment services and diagnostic delay and may be relevant in terms of etiology, suitable interventions, and outcome,” concluded the investigators.
Goldstein LH, Robinson EJ, Reuber M, et al. Characteristics of 698 patients with dissociative seizures: A UK multicenter study [published online October 13, 2019]. Epilepsia. doi:10.1111/epi.16350