Novel Association Observed Between Functional Seizures, Cerebrovascular Disease

Contemporary Clinic ®interviewedLea Davis, PhD, an associate professor of medicine in the Department of Medicine at Vanderbilt University Medical Center and an investigator in the Vanderbilt Genetics Institute, on a recent study she co-authored that was published in JAMA Network Open on the epidemiology of functional seizures among adults treated at a university hospital.

Alana Hippensteele: Could you explain further the novel association in your findings between functional seizures and cerebrovascular disease?

Lea Davis: Yeah. So, in our data, what we saw was basically that that the presence of functional seizures and the presence of cerebrovascular disease, or more specifically stroke, tended to co-occur at a rate higher than what we would expect by chance, just based on how common those 2 conditions are independently.

So, we saw them actually occurring together more often than we would expect. We did do some work to try to figure out which might be coming first, the functional seizure condition or the stroke event.

The challenge with that though is that patients with functional seizures often experience like a 7 to 8 year diagnostic odyssey, so by the time they actually get diagnosed with functional seizures they may have been having functional seizures for a very long time and that can be really hard to tease apart in the medical record.

So, that's part of our challenge in trying to understand the relationship between these 2. I will also say that it's not uncommon for stroke patients to experience or to develop epilepsy after a stroke, and so one of the recommendations that we make in the paper is that, for anybody who's experiencing seizures post-stroke who is not pretty quickly responding to anti-epileptic medications, they should be referred to a video EEG to determine if this is a functional seizure condition or epileptic seizures.