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

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.

Metadata

Item Type:	Article
Authors/Creators:	Goldstein, LH Robinson, EJ Reuber, M https://orcid.org/0000-0002-4104-6705 Chalder, T Callaghan, H Eastwood, C Landau, S McCrone, P Medford, N Mellers, JDC Moore, M Mosweu, I Murray, J Perdue, I Pilecka, I Richardson, MP Carson, A Stone, J Abe, A Adab, N Agrawal, N Allroggen, H Alvares, D Andrews, T Angus‐Leppan, H Aram, J Armstrong, R Atalaia, A Bagary, M Bennett, M Black, T Blackburn, D https://orcid.org/0000-0001-8886-1283 Bodani, M Broadhurst, M Brockington, A Bruno, E Buckley, M Burness, C Chalmers, R Chong, S Chowdhury, M Chowdury, F Cikurel, K Cocco, G Cock, H Cooper, S Cope, S Copping, A Day, E Delamont, R Dennis, G Derry, C Devlin, R Dickson, JM https://orcid.org/0000-0002-1361-2714 Diehl, B Donnelly, C Duncan, S Edwards, M Ellawella, S Ellis, C Elvish, J Elwes, R Eriemo, S Eriksson, S Evans, K Faruqui, R Feehan, S Finnerty, G Flores, L Firth, N https://orcid.org/0000-0003-1984-6869 Fung, R Gardiner, P Graham, C Green‐Thompson, Z Grunewald, R Hadden, R Hamandi, K Harding, R Harikrishnan, S Harrison, S Healy, H Hewamadduma, C Higgins, S Howell, S Hunt, H Hussain, A Innocente, M Jensch, G Johnson, M Jordan, H Karlsson, J Kelso, A Kemp, S Knibb, J Kock, N Koutroumanidis, M Kovac, S Kumar, G Laker, A Leschziner, G Liu, R Lozsadi, D Ludwig, L MacDonald, B MacGregor, L Maguire, M Manford, M Martino, D McCorry, D McGorlick, A McKeown, K McKevitt, F Meadow, A Memon, S Miorelli, A Mitchell, C Mitchell, TN Moffitt, V Moran, N Morgan‐Boon, A Moriarty, J Mula, M Mullatti, N Nashef, L O'Hara, D Oakley, L O'Sullivan, S Page, L Patel, D Petrochilos, P Phoenix, D Pickerell, W Pieters, T Poole, N Price, G Protheroe, D Pullicino, P Purnell, J Quirk, J Rajakulendran, S Read, J Ridha, B Rockliffe‐Fidler, C Rowbottom, C Rugg‐Gunn, F Sachar, A Saha, R Saldanha, G Samarasekera, S Sanchez Sanchez, V Santhouse, A Scholes, K Shetty, A Shotbolt, P Simkiss, R Singh, J Sivagnanasundaram, J Slaght, S Smith, P Sokhi, D Stanton, B Suvorova, L Tahir, T Taylor, R Teare, L Tedesco, L Teo, J Thorpe, J Toplis, L Tsakopoulou, M Tylova, I Vick, T Vinnicombe, J Walker, M Walsh, C Watson, G Webb, T Wehner, T Welch, K Weyrich, K Whittaker, M Wickremaratchi, M Wicks, L
Copyright, Publisher and Additional Information:	© 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 Creative Commons Attribution License, (http://creativecommons.org/licenses/by/4.0/) which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Keywords:	demographics; deprivation; dissociative (nonepileptic) seizures; onset; semiology
Dates:	Accepted: 3 September 2019 Published (online): 13 October 2019 Published: November 2019
Institution:	The University of Sheffield
Academic Units:	The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research The University of Sheffield > Sheffield Teaching Hospitals
Depositing User:	Symplectic Sheffield
Date Deposited:	10 Feb 2020 15:07
Last Modified:	10 Feb 2020 15:31
Status:	Published
Publisher:	Wiley
Refereed:	Yes
Identification Number:	10.1111/epi.16350
Related URLs:	Author
Open Archives Initiative ID (OAI ID):	oai:eprints.whiterose.ac.uk:155895

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

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