Universidade Federal de Santa Catarina, Florianópolis, Brazil.
Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Epilepsia. 2023 Nov;64(11):3082-3098. doi: 10.1111/epi.17752. Epub 2023 Sep 11.
Ictal injuries have long been considered typical signs of epileptic seizures. However, studies have shown that patients with functional seizures (FS)-also named psychogenic nonepileptic seizures-can also present these signs, misleading physicians and delaying a correct diagnosis. This systematic review aimed to assess the prevalence of injuries from FS.
A literature search was performed in PubMed, Embase, LILACS (Latin American and Caribbean Health Sciences Literature), Scopus, Web of Science, PsycINFO, Google Scholar, OpenGrey, and ProQuest. Observational studies were included. The risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist for studies reporting prevalence data. RStudio was used for meta-analyses. Cumulative evidence was evaluated according to Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria.
From the 2607 identified records, 41 studies were included in the qualitative synthesis, and 28 were included in meta-analyses. A meta-analysis of 13 studies, including 1673 individuals, resulted in an overall lifetime prevalence of injuries due to FS per person of 25% (95% confidence interval [CI] = 19%-32%, I = 88%). Considering a limited period (video-electroencephalographic [VEEG] monitoring days), a meta-analysis of 13 studies, including 848 individuals, resulted in an injury prevalence due to FS per person of .7% (95% CI = 0%-3%, I = 73%). Also, a meta-analysis of eight studies, including 1000 individuals, resulted in a prevalence of injuries per FS of .1% (95% CI = 0%-.98%, I = 49%). The certainty in cumulative evidence assessed by GRADE was rated "very low" for lifetime prevalence of injuries per person, "low" for prevalence per person during VEEG monitoring, and "moderate" for prevalence per number of FS.
Overall pooled lifetime prevalence of injuries due to FS per person was 25%. In comparison, the prevalence of injuries per person during VEEG monitoring and per functional seizure was .7% and .1%, respectively. [Correction added on 07 October 2023, after first online publication: In the preceding sentence, 'consecutively' was corrected to 'respectively'.] The evidence of the occurrence of injuries due to FS breaks the paradigm that epileptic seizures can cause injuries but FS cannot.
癫痫发作的典型特征之一一直被认为是发作性损伤。然而，研究表明，功能性发作（FS）——也称为心因性非癫痫性发作——的患者也可能出现这些体征，这会误导医生并延迟正确的诊断。本系统评价旨在评估 FS 发作性损伤的发生率。
对 PubMed、Embase、LILACS（拉丁美洲和加勒比健康科学文献）、Scopus、Web of Science、PsycINFO、Google Scholar、OpenGrey 和 ProQuest 进行文献检索。纳入观察性研究。使用 Joanna Briggs 研究所（JBI）检查表评估报告患病率数据的研究的偏倚风险。使用 RStudio 进行荟萃分析。根据推荐、评估、制定和评价（GRADE）标准评估累积证据。
从 2607 条记录中，定性综合分析纳入了 41 项研究，荟萃分析纳入了 28 项研究。对 13 项研究（包括 1673 人）的荟萃分析显示，FS 患者终生发作性损伤的总体发生率为 25%（95%置信区间[CI]为 19%-32%，I 为 88%）。考虑到有限的时间段（视频-脑电图[VEEG]监测日），对 13 项研究（包括 848 人）的荟萃分析显示，FS 患者的发作性损伤发生率为 0.7%（95% CI 为 0%-3%，I 为 73%）。此外，对 8 项研究（包括 1000 人）的荟萃分析显示，FS 患者的损伤发生率为 0.1%（95% CI 为 0%-.98%，I 为 49%）。通过 GRADE 评估的累积证据的确定性为“非常低”，用于 FS 患者的终生发作性损伤发生率，“低”用于 VEEG 监测期间的患者发生率，以及“中等”用于 FS 数量的患者发生率。
FS 患者终生发作性损伤的总体发生率为 25%。相比之下，VEEG 监测期间和 FS 期间的损伤发生率分别为 0.7%和 0.1%。FS 发作性损伤的证据打破了癫痫发作会导致损伤而 FS 不会导致损伤的这一范式。
