Functional seizures are associated with cerebrovascular disease and functional stroke is more common in patients with..., 2022, Fox et al

[Andy]

Full title: Functional seizures are associated with cerebrovascular disease and functional stroke is more common in patients with functional seizures than epileptic seizures

Highlights

• Cerebrovascular disease was found to be associated with functional seizures.
• Functional stroke is more common in those with functional seizures than epilepsy.
• More than one functional neurological disorder may occur in the same patient.

Abstract

Purpose
To characterize the relationship between functional seizures (FSe), cerebrovascular disease (CVD), and functional stroke.

Method
A retrospective case-control study of 189 patients at a single large tertiary medical center. We performed a manual chart review of medical records of patients with FSe or epileptic seizures (ES), who also had ICD code evidence of CVD. The clinical characteristics of FSe, ES, CVD, and functional stroke were recorded. Logistic regression and Welch’s t-tests were used to evaluate the differences between the FSe and ES groups.

Results
Cerebrovascular disease was confirmed in 58.7% and 87.6% of patients with FSe or ES through manual chart review. Stroke was significantly more common in patients with ES (76.29%) than FSe (43.48%) (p = 4.07 × 10−6). However, compared to nonepileptic controls FSe was associated with both CVD (p < 0.0019) and stroke (p < 6.62 × 10−10). Functional stroke was significantly more common in patients with FSe (39.13%) than patients with ES (4.12%) (p = 4.47 × 10−9). Compared to patients with ES, patients with FSe were younger (p = 0.00022), more likely to be female (p = 0.00040), and more likely to have comorbid mental health needs including anxiety (p = 1.06 × 10−6), PTSD or history of trauma (e.g., sexual abuse) (p = 1.06 × 10−13), and bipolar disorder (p = 0.0011).

Conclusion
Our results confirm the initial observation of increased CVD in patients with FSe and further suggest that patients with FSe may be predisposed to developing another functional neurological disorder (FND) (i.e., functional stroke). We speculate that this may be due to shared risk factors and pathophysiological processes that are common to various manifestations of FND.

Paywall, https://www.epilepsybehavior.com/article/S1525-5050(22)00031-2/fulltext

 

[Sean]

More than one functional neurological disorder may occur in the same patient.

Now they are just taking the piss.

 

[chrisb]

They won't even bother to test it.

 

[alktipping]

i wonder if the authors understand how ambiguous the word functional has become and what the bps type authors infer from this term .

 

[Milo]

i wonder if the authors understand how ambiguous the word functional has become and what the bps type authors infer from this term .

It’s by design. Confuse the hell out of everyone.

 

[rvallee]

It's 100% a feature, definitely not a bug. In fact it's clearly reflected in the literature that they can't say what they mean since the patients look at them like they're being asked to grow a second tiny head on their elbow. Abuse of Orwellian language is a core feature of psychosomatic medicine, it can't even exist without abusing this ambiguity. Or at least not since the system of insane asylums was mostly dismantled, there they could do and say as they please and many seem to miss having that freedom.

Catholic priests used to do mass and speak in latin so the people wouldn't learn to doubt their beliefs. Same idea here, controlling language, making it impossible for those affected to know how it affects them, is important to control people. It's not even subtle, it's openly discussed in academic papers and textbooks. It's even how some physicians are trained to deal with "difficult" patients.

But some of it is sincerely derived from doublethink, they actually do believe what they say, they just have mental conflicts in their minds allowing them to hold mutually exclusive ideas. They can sincerely switch back and forth between dismissing something as just mental illness, then being shocked, SHOCKED, that someone would take mental illness any less seriously than physical illness, which is universal and not at all subtle in medicine, mental health is basically still stuck at where medicine was at the times of the humours.