Characteristics of 698 patients with dissociative seizures: A UK multicenter study

Objective We aimed to characterize the demographics of adults with dissociative (nonepileptic) seizures, placing emphasis on distribution of age at onset, male:female ratio, levels of deprivation, and dissociative seizure semiology. Methods We collected demographic and clinical data from 698 adults...

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Published inEpilepsia (Copenhagen) Vol. 60; no. 11; pp. 2182 - 2193
Main Authors Goldstein, Laura H., Chalder, Trudie, Eastwood, Carole, Landau, Sabine, Medford, Nick, Moore, Michele, Mosweu, Iris, Perdue, Iain, Pilecka, Izabela, Richardson, Mark P., Carson, Alan, Stone, Jon, Abe, Anne‐Mary, Agrawal, Niruj, Allroggen, Holger, Angus‐Leppan, Heather, Armstrong, Richard, Bennett, Masha, Blackburn, Daniel, Bodani, Mayur, Broadhurst, Mark, Brockington, Alice, Bruno, Elisa, Buckley, Mary, Burness, Christine, Chong, Sam, Chowdury, Fahmida, Cikurel, Katia, Cocco, Giovanni, Cock, Hannah, Copping, Amy, Delamont, Robert, Dennis, Gary, Derry, Christopher, Devlin, Rebecca, Dickson, Jon M, Duncan, Susan, Elvish, Jennifer, Elwes, Robert, Eriemo, Sandra, Eriksson, Sofia, Faruqui, Rafey, Flores, Lorena, Firth, Nick, Graham, Christopher, Green‐Thompson, Zayn, Grunewald, Richard, Hamandi, Khalid, Harding, Rachel, Harikrishnan, Sreedharan, Harrison, Simon, Healy, Helen, Hunt, Heloise, Hussain, Abrar, Jensch, Graham, Jordan, Harriet, Knibb, Jonathan, Kock, Norman, Koutroumanidis, Michael, Kovac, Stjepana, Laker, Andy, Liu, Rebecca, Ludwig, Lea, MacDonald, Bridget, MacGregor, Lindsey, Manford, Mark, McKeown, Kenneth, McKevitt, Fiona, Memon, Shafqat, Mitchell, Tejal N, Moran, Nicholas, Morgan‐Boon, Aimee, Nashef, Lina, Page, Lisa, Petrochilos, Panayiota, Phoenix, Danielle, Pickerell, William, Poole, Norman, Protheroe, David, Purnell, James, Rugg‐Gunn, Fergus, Sachar, Amrit, Samarasekera, Shanika, Sanchez Sanchez, Violeta, Santhouse, Alastair, Shetty, Abhijeeth, Shotbolt, Paul, Simkiss, Rachel, Sivagnanasundaram, Jananee, Slaght, Sean, Sokhi, Dilraj, Suvorova, Liya, Taylor, Ruth, Teare, Lara, Tedesco, Lorenza, Toplis, Laura, Tsakopoulou, Myrto, Vick, Tracey, Wehner, Tim, Weyrich, Kirstin
Format Journal Article
LanguageEnglish
Published United States John Wiley and Sons Inc 01.11.2019
Subjects
Adult
Cohort Studies
demographics
deprivation
dissociative (nonepileptic) seizures
Dissociative Disorders - diagnosis
Dissociative Disorders - epidemiology
Dissociative Disorders - physiopathology
Electroencephalography - trends
Female
Full‐length Original Research
Humans
Male
Middle Aged
onset
Retrospective Studies
Seizures - diagnosis
Seizures - epidemiology
Seizures - physiopathology
semiology
United Kingdom - epidemiology
Young Adult
United Kingdom
deprivation
semiology
dissociative (nonepileptic) seizures
onset
demographics
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Abstract Objective We aimed to characterize the demographics of adults with dissociative (nonepileptic) seizures, placing emphasis on distribution of age at onset, male:female ratio, levels of deprivation, and dissociative seizure semiology. Methods We collected demographic and clinical data from 698 adults with dissociative seizures recruited to the screening phase of the CODES (Cognitive Behavioural Therapy vs Standardised Medical Care for Adults With Dissociative Non‐Epileptic Seizures) trial from 27 neurology/specialist epilepsy clinics in the UK. We described the cohort in terms of age, age at onset of dissociative seizures, duration of seizure disorder, level of socioeconomic deprivation, and other social and clinical demographic characteristics and their associations. Results In what is, to date, the largest study of adults with dissociative seizures, the overall modal age at dissociative seizure onset was 19 years; median age at onset was 28 years. Although 74% of the sample was female, importantly the male:female ratio varied with age at onset, with 77% of female but only 59% of male participants developing dissociative seizures by the age of 40 years. The frequency of self‐reported previous epilepsy was 27%; nearly half of these epilepsy diagnoses were retrospectively considered erroneous by clinicians. Patients with predominantly hyperkinetic dissociative seizures had a shorter disorder duration prior to diagnosis in this study than patients with hypokinetic seizures (P < .001); dissociative seizure type was not associated with gender. Predominantly hyperkinetic seizures were most commonly seen in patients with symptom onset in their late teens. Thirty percent of the sample reported taking antiepileptic drugs; this was more common in men. More than 50% of the sample lived in areas characterized by the highest levels of deprivation, and more than two‐thirds were unemployed. Significance Females with dissociative seizures were more common at all ages, whereas the proportion of males increased with age at onset. This disorder was associated with socioeconomic deprivation. Those with hypokinetic dissociative seizures may be at risk for delayed diagnosis and treatment.
AbstractList We aimed to characterize the demographics of adults with dissociative (nonepileptic) seizures, placing emphasis on distribution of age at onset, male:female ratio, levels of deprivation, and dissociative seizure semiology.OBJECTIVEWe aimed to characterize the demographics of adults with dissociative (nonepileptic) seizures, placing emphasis on distribution of age at onset, male:female ratio, levels of deprivation, and dissociative seizure semiology.We collected demographic and clinical data from 698 adults with dissociative seizures recruited to the screening phase of the CODES (Cognitive Behavioural Therapy vs Standardised Medical Care for Adults With Dissociative Non-Epileptic Seizures) trial from 27 neurology/specialist epilepsy clinics in the UK. We described the cohort in terms of age, age at onset of dissociative seizures, duration of seizure disorder, level of socioeconomic deprivation, and other social and clinical demographic characteristics and their associations.METHODSWe collected demographic and clinical data from 698 adults with dissociative seizures recruited to the screening phase of the CODES (Cognitive Behavioural Therapy vs Standardised Medical Care for Adults With Dissociative Non-Epileptic Seizures) trial from 27 neurology/specialist epilepsy clinics in the UK. We described the cohort in terms of age, age at onset of dissociative seizures, duration of seizure disorder, level of socioeconomic deprivation, and other social and clinical demographic characteristics and their associations.In what is, to date, the largest study of adults with dissociative seizures, the overall modal age at dissociative seizure onset was 19 years; median age at onset was 28 years. Although 74% of the sample was female, importantly the male:female ratio varied with age at onset, with 77% of female but only 59% of male participants developing dissociative seizures by the age of 40 years. The frequency of self-reported previous epilepsy was 27%; nearly half of these epilepsy diagnoses were retrospectively considered erroneous by clinicians. Patients with predominantly hyperkinetic dissociative seizures had a shorter disorder duration prior to diagnosis in this study than patients with hypokinetic seizures (P < .001); dissociative seizure type was not associated with gender. Predominantly hyperkinetic seizures were most commonly seen in patients with symptom onset in their late teens. Thirty percent of the sample reported taking antiepileptic drugs; this was more common in men. More than 50% of the sample lived in areas characterized by the highest levels of deprivation, and more than two-thirds were unemployed.RESULTSIn what is, to date, the largest study of adults with dissociative seizures, the overall modal age at dissociative seizure onset was 19 years; median age at onset was 28 years. Although 74% of the sample was female, importantly the male:female ratio varied with age at onset, with 77% of female but only 59% of male participants developing dissociative seizures by the age of 40 years. The frequency of self-reported previous epilepsy was 27%; nearly half of these epilepsy diagnoses were retrospectively considered erroneous by clinicians. Patients with predominantly hyperkinetic dissociative seizures had a shorter disorder duration prior to diagnosis in this study than patients with hypokinetic seizures (P < .001); dissociative seizure type was not associated with gender. Predominantly hyperkinetic seizures were most commonly seen in patients with symptom onset in their late teens. Thirty percent of the sample reported taking antiepileptic drugs; this was more common in men. More than 50% of the sample lived in areas characterized by the highest levels of deprivation, and more than two-thirds were unemployed.Females with dissociative seizures were more common at all ages, whereas the proportion of males increased with age at onset. This disorder was associated with socioeconomic deprivation. Those with hypokinetic dissociative seizures may be at risk for delayed diagnosis and treatment.SIGNIFICANCEFemales with dissociative seizures were more common at all ages, whereas the proportion of males increased with age at onset. This disorder was associated with socioeconomic deprivation. Those with hypokinetic dissociative seizures may be at risk for delayed diagnosis and treatment.
We aimed to characterize the demographics of adults with dissociative (nonepileptic) seizures, placing emphasis on distribution of age at onset, male:female ratio, levels of deprivation, and dissociative seizure semiology. We collected demographic and clinical data from 698 adults with dissociative seizures recruited to the screening phase of the CODES (Cognitive Behavioural Therapy vs Standardised Medical Care for Adults With Dissociative Non-Epileptic Seizures) trial from 27 neurology/specialist epilepsy clinics in the UK. We described the cohort in terms of age, age at onset of dissociative seizures, duration of seizure disorder, level of socioeconomic deprivation, and other social and clinical demographic characteristics and their associations. In what is, to date, the largest study of adults with dissociative seizures, the overall modal age at dissociative seizure onset was 19 years; median age at onset was 28 years. Although 74% of the sample was female, importantly the male:female ratio varied with age at onset, with 77% of female but only 59% of male participants developing dissociative seizures by the age of 40 years. The frequency of self-reported previous epilepsy was 27%; nearly half of these epilepsy diagnoses were retrospectively considered erroneous by clinicians. Patients with predominantly hyperkinetic dissociative seizures had a shorter disorder duration prior to diagnosis in this study than patients with hypokinetic seizures (P < .001); dissociative seizure type was not associated with gender. Predominantly hyperkinetic seizures were most commonly seen in patients with symptom onset in their late teens. Thirty percent of the sample reported taking antiepileptic drugs; this was more common in men. More than 50% of the sample lived in areas characterized by the highest levels of deprivation, and more than two-thirds were unemployed. Females with dissociative seizures were more common at all ages, whereas the proportion of males increased with age at onset. This disorder was associated with socioeconomic deprivation. Those with hypokinetic dissociative seizures may be at risk for delayed diagnosis and treatment.
Objective We aimed to characterize the demographics of adults with dissociative (nonepileptic) seizures, placing emphasis on distribution of age at onset, male:female ratio, levels of deprivation, and dissociative seizure semiology. Methods We collected demographic and clinical data from 698 adults with dissociative seizures recruited to the screening phase of the CODES (Cognitive Behavioural Therapy vs Standardised Medical Care for Adults With Dissociative Non‐Epileptic Seizures) trial from 27 neurology/specialist epilepsy clinics in the UK. We described the cohort in terms of age, age at onset of dissociative seizures, duration of seizure disorder, level of socioeconomic deprivation, and other social and clinical demographic characteristics and their associations. Results In what is, to date, the largest study of adults with dissociative seizures, the overall modal age at dissociative seizure onset was 19 years; median age at onset was 28 years. Although 74% of the sample was female, importantly the male:female ratio varied with age at onset, with 77% of female but only 59% of male participants developing dissociative seizures by the age of 40 years. The frequency of self‐reported previous epilepsy was 27%; nearly half of these epilepsy diagnoses were retrospectively considered erroneous by clinicians. Patients with predominantly hyperkinetic dissociative seizures had a shorter disorder duration prior to diagnosis in this study than patients with hypokinetic seizures (P < .001); dissociative seizure type was not associated with gender. Predominantly hyperkinetic seizures were most commonly seen in patients with symptom onset in their late teens. Thirty percent of the sample reported taking antiepileptic drugs; this was more common in men. More than 50% of the sample lived in areas characterized by the highest levels of deprivation, and more than two‐thirds were unemployed. Significance Females with dissociative seizures were more common at all ages, whereas the proportion of males increased with age at onset. This disorder was associated with socioeconomic deprivation. Those with hypokinetic dissociative seizures may be at risk for delayed diagnosis and treatment.
Author Gardiner, Paula
Stanton, Biba
Kemp, Steven
Sivagnanasundaram, Jananee
Sokhi, Dilraj
Maguire, Melissa
Watson, Gillian
Cocco, Giovanni
Hadden, Robert
Leschziner, Guy
Smith, Philip
Cooper, Sarah
Tahir, Tayyeb
Carson, Alan
Black, Tamsin
Brockington, Alice
Simkiss, Rachel
Wehner, Tim
Purnell, James
MacGregor, Lindsey
Fung, Robert
Mitchell, Clinton
Richardson, Mark P.
Donnelly, Clare
Eriksson, Sofia
Koutroumanidis, Michael
Meadow, Anna
Taylor, Ruth
Vick, Tracey
Dennis, Gary
McKevitt, Fiona
Poole, Norman
Mellers, John D. C.
Chalmers, Richard
Patel, Darshna
Sachar, Amrit
Tedesco, Lorenza
Lozsadi, Dora
Rugg‐Gunn, Fergus
Cope, Sarah
Sanchez Sanchez, Violeta
Robinson, Emily J.
Elvish, Jennifer
Singh, Jasvinder
Adab, Naghme
Hussain, Abrar
Burness, Christine
Shetty, Abhijeeth
Chong, Sam
Wickremaratchi, Mirdhu
Ridha, Basil
Feehan, Sarah
Ellawella, Shan
Delamont, Robert
O'Hara, Daniel
Howell, Stephen
Read, Julie
Suvorova, Liya
Weyrich, Kirstin
Harding, Rachel
Knibb, Jonathan
Scholes, Karen
Buckley, Mary
Memon, Shafqat
Kelso, Andrew
Liu, Rebecca
Samarasekera, Shanik
AuthorAffiliation 3 Academic Neurology Unit Royal Hallamshire Hospital University of Sheffield Sheffield UK
1 Institute of Psychiatry, Psychology, and Neuroscience King's College London London UK
2 School of Population Health and Environmental Sciences King's College London London UK
4 UK Centre for Clinical Brain Sciences University of Edinburgh Edinburgh UK
5 South London and Maudsley National Health Service Foundation Trust London UK
6 Centre for Social Justice and Global Responsibility School of Law and Social Sciences London South Bank University London UK
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/31608436$$D View this record in MEDLINE/PubMed
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Kemp, Steven
Maguire, Melissa
Cocco, Giovanni
Hadden, Robert
Leschziner, Guy
Cooper, Sarah
Black, Tamsin
Brockington, Alice
MacGregor, Lindsey
Fung, Robert
Mitchell, Clinton
Donnelly, Clare
Eriksson, Sofia
Koutroumanidis, Michael
Meadow, Anna
Dennis, Gary
McKevitt, Fiona
Chalmers, Richard
Lozsadi, Dora
Cope, Sarah
Elvish, Jennifer
Adab, Naghme
Hussain, Abrar
Burness, Christine
Chong, Sam
Feehan, Sarah
Ellawella, Shan
Delamont, Robert
Howell, Stephen
Harding, Rachel
Knibb, Jonathan
Buckley, Mary
Memon, Shafqat
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Liu, Rebecca
Evans, Kerry
Atalaia, Antonio
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Aram, Julia
Cock, Hannah
Grunewald, Richard
Devlin, Rebecca
Hunt, Heloise
Kock, Norman
Bodani, Mayur
Chowdhury, Muhammad
Bruno, Elisa
Jensch, Graham
Bagary, Manny
Eriemo, Sandra
Mitchell, Tejal N
Manford, Mark
Flores, Lorena
Broadhurst, Mark
Dickson, Jon M
Ludwig, Lea
Angus-Leppan, Heather
Ellis, Cathy
Higgins, Stephen
Green-Thompson, Zayn
Cikurel, Katia
Faruqui, Rafey
Elwes, Robert
Diehl, Beate
MacDonald, Bridget
Day, Elana
Duncan, Susan
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Copyright 2019 The Authors. published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy
2019 The Authors. Epilepsia published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy.
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– notice: 2019 The Authors. Epilepsia published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy.
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Issue 11
Keywords deprivation
semiology
dissociative (nonepileptic) seizures
onset
demographics
Language English
License Attribution
2019 The Authors. Epilepsia published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy.
This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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content type line 23
Alan Carson and Jon Stone contributed equally.
See Appendix.
Trial registration: Current Controlled Trials ISRCTN05681227; ClinicalTrials.gov NCT02325544
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Snippet Objective We aimed to characterize the demographics of adults with dissociative (nonepileptic) seizures, placing emphasis on distribution of age at onset,...
We aimed to characterize the demographics of adults with dissociative (nonepileptic) seizures, placing emphasis on distribution of age at onset, male:female...
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SubjectTerms Adult
Cohort Studies
demographics
deprivation
dissociative (nonepileptic) seizures
Dissociative Disorders - diagnosis
Dissociative Disorders - epidemiology
Dissociative Disorders - physiopathology
Electroencephalography - trends
Female
Full‐length Original Research
Humans
Male
Middle Aged
onset
Retrospective Studies
Seizures - diagnosis
Seizures - epidemiology
Seizures - physiopathology
semiology
United Kingdom - epidemiology
Young Adult
Title Characteristics of 698 patients with dissociative seizures: A UK multicenter study
URI https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fepi.16350
https://www.ncbi.nlm.nih.gov/pubmed/31608436
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https://pubmed.ncbi.nlm.nih.gov/PMC6899659
Volume 60
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