Sex Differences in Functional Seizures

Abstract

Objectives: To examine sex-differences in demographic and clinical characteristics in a cohort of individuals diagnosed with functional seizures (FS) and to investigate whether exposure to childhood sexual trauma (CST) is associated with distinct disease characteristics in men vs women.
Methods: Prospective data from 230 patients with video- EEG confirmed FS from November 2014-May 2018 were analyzed. Demographic and clinical characteristics, including comorbid psychiatric diagnoses and reported semiology were obtained through a semi-structured neuropsychiatric interview. Self-rating questionnaires were used to obtain measurements of psychopathology severity, comorbid psychiatric symptomatology, and quality of life. Independent T-tests were used to compare means of continuous measures and Fisher’s exact test were used to compare frequencies of categorical variables.
Results: Of 230 individuals included in the analysis, 84% were women, in line with previous epidemiological reports. In both sexes, peak onset of FS was similar, although women presented earlier. There were differences in reported spell phenotype with women having a greater frequency of pelvic movements, speech impairment, somatosensory impairment and episodes occurring during in bed during subjective sleep. Exposure to CST was greater in women with FS compared to men (p= 0.002). Women with CST were more likely to report FS out of subjective sleep, have event-associated injuries, somatosensory symptoms, atonia, head movements, opisthotonos/ motor stiffening and shaking and had an increased frequency of psychiatric comorbidities compared to those without CST.
Female Male
Ethnicity % Ethnicity %
White 72.2 White 88.9
Black 12.9 Black 2.8
Hispanic 13.4 Hispanic 5.6
Asian 0.5 Other 2.8
Other 1.0

Conclusion: There are sex differences in FS including seizure semiology and the type of psychiatric comorbidities. Some of these differences were more pronounced in women with CST. Our findings suggest that gender-tailored approaches should be considered in the management of FS.

Research Context

Functional seizures (FS) are a common, disabling disorder that predominantly affects women. There is extensive evidence that disorders which primarily affect women are often neglected in medical research. The inadequate study of FS mirrors such neglect. A history of sexual trauma in this population is much higher than in the general population and psychiatric comorbidities, such as depression and post-traumatic stress disorder are common. These risk factors are more prevalent in women who have FS. We aimed to describe baseline characteristics in women vs men with FS including clinical presentation, psychiatric comorbidities, and disease onset. We hypothesized women with FS have a younger age of onset, more frequent mood, anxiety and trauma-related disorders and report semiology that reflected a higher degree of dissociative tendencies. Our preliminary findings support this hypothesis. Further research on sex differences would allow clinicians to appropriately treat this population.

Sex Differences in Functional Seizures

Abstract

Research Context

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