Department of Neurology, Nancy Regional University Hospital Center, Nancy, France.
National Center for Scientific Research, Research Center for Automatic Control, Mixed Unit of Research 7039, University of Lorraine, Nancy, France.
Epilepsia. 2022 Jun;63(6):1500-1515. doi: 10.1111/epi.17230. Epub 2022 Apr 3.
Current concepts highlight the neurological and psychological heterogeneity of functional/dissociative seizures (FDS). However, it remains uncertain whether it is possible to distinguish between a limited number of subtypes of FDS disorders. We aimed to identify profiles of distinct FDS subtypes by cluster analysis of a multidimensional dataset without any a priori hypothesis.
We conducted an exploratory, prospective multicenter study of 169 patients with FDS. We collected biographical, trauma (childhood and adulthood traumatic experiences), semiological (seizure characteristics), and psychopathological data (psychiatric comorbidities, dissociation, and alexithymia) through psychiatric interviews and standardized scales. Clusters were identified by the Partitioning Around Medoids method. The similarity of patients was computed using Gower distance. The clusters were compared using analysis of variance, chi-squared, or Fisher exact tests.
Three patient clusters were identified in this exploratory, hypothesis-generating study and named on the basis of their most prominent characteristics: A "No/Single Trauma" group (31.4%), with more male patients, intellectual disabilities, and nonhyperkinetic seizures, and a low level of psychopathology; A "Cumulative Lifetime Traumas" group (42.6%), with clear female predominance, hyperkinetic seizures, relatively common comorbid epilepsy, and a high level of psychopathology; and A "Childhood Traumas" group (26%), commonly with comorbid epilepsy, history of childhood sexual abuse (75%), and posttraumatic stress disorder, but also with a high level of anxiety and dissociation.
Although our cluster analysis was undertaken without any a priori hypothesis, the nature of the trauma history emerged as the most important differentiator between three common FDS disorder subtypes. This subdifferentiation of FDS disorders may facilitate the development of more specific therapeutic programs for each patient profile.
目前的概念强调了功能性/分离性发作（FDS）的神经和心理异质性。然而，目前尚不确定是否有可能区分 FDS 障碍的少数几个亚型。我们旨在通过无先验假设的多维数据集的聚类分析来确定不同 FDS 亚型的特征。
我们对 169 例 FDS 患者进行了一项探索性、前瞻性多中心研究。我们通过精神科访谈和标准化量表收集了传记、创伤（儿童期和成年期创伤经历）、半症状（发作特征）和精神病理学数据（精神共病、分离和述情障碍）。使用 Partitioning Around Medoids 方法识别聚类。使用 Gower 距离计算患者之间的相似性。使用方差分析、卡方检验或 Fisher 精确检验比较聚类。
在这项探索性、产生假设的研究中，我们确定了三个患者聚类，并根据其最突出的特征命名：A“无/单一创伤”组（31.4%），男性患者较多，智力障碍，非运动性发作，精神病理学水平较低；A“累积终生创伤”组（42.6%），明显以女性为主，运动性发作，相对常见的共患癫痫，精神病理学水平较高；A“儿童期创伤”组（26%），常伴有共患癫痫、童年性虐待史（75%）和创伤后应激障碍，但也伴有较高的焦虑和分离。
尽管我们的聚类分析是在没有任何先验假设的情况下进行的，但创伤史的性质是区分三种常见 FDS 障碍亚型的最重要因素。这种 FDS 障碍的细分可能有助于为每个患者特征制定更具体的治疗方案。
