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Researchers examined why patients who experience seizures may also face a higher degree of vascular disease.

“Several recent studies have shown that patients with functional seizures are at an elevated risk for death,” Jonah Fox, MD, explains. “It is not completely clear why this might be the case. A previous study I conducted showed elevated rates of cerebrovascular disease in patients with functional seizures, and another study in the literature showed elevated rates of vascular disease in those with functional seizures. There is also research showing elevated cortisol levels in patients with functional seizures.”

For a study published in Epilepsy and Behavior, Dr. Fox aimed to determine why these patients may experience a higher degree of vascular disease and whether this relates to the higher mortality rate in these patients.

“We retrospectively identified patients who were admitted to the epilepsy monitoring unit and received a definitive diagnosis of functional seizures or epilepsy,” he says. “We then compared vascular risk factors between them.”

Vascular Risk Factors Higher in Those With Seizures

The study included 147 patients with epilepsy and 123 with functional seizures. Patients with epilepsy had a longer disease duration at the time of admission compared with those with functional seizures (16.84 years vs 9.03 years; P<0.0001). The functional seizure group had more women (78.05% vs. 55.78%; P=0.0002) and a higher estimated mean seizure frequency per month (37.19 vs 14.17; P=0.0012).

Generally, vascular-related clinical characteristics were more prevalent in the functional seizures group compared with the epilepsy group:

• Hyperlipidemia: 30.89% versus 17.01% (P=0.0091)
• Obesity 63.41% versus 30.61% (P<0.0001)
• History of known hypertension: 36.59% versus 23.13% (P=0.022)

Patients in the functional seizures group also had a higher prevalence of a history of known hypertension and/or mean BP above 130/80 during admission: 57.72% versus 38.78% (P=0.0022). However, patients with epilepsy had more blood pressure measurements taken during admission (median: 9.03 vs 8.12; P<0.0001).

The study team used a logistic regression model to determine that functional seizures were independently associated with high BP (OR, 2.47; 95% CI, 1.10-5.69), hyperlipidemia (OR, 3.38; 95% CI, 1.35-8.86), and obesity (OR, 4.25; 95% CI, 2.22-8.36) compared with epilepsy. There was no significant difference in the prevalence of diabetes or current tobacco use between groups.

“The most important results to emphasize would be that rates of hypertension, obesity, and hyperlipidemia are elevated in patients with functional seizures,” Dr. Fox notes.

Implications for Clinicians & Future Research

Overall, the findings show that patients with functional seizures experience a greater prevalence of vascular risk factors that may contribute to the development of cerebrovascular and cardiovascular disease, as well as mortality.

The researchers also note that many of the conditions they identified represent modifiable determinants of vascular disease and mortality risk.

“If you are a clinician caring for patients with functional seizures, it is important to be cognizant that this condition is associated with various comorbidities that could be associated with an elevated vascular risk and, therefore, a potentially elevated risk for complications, including death,” Dr. Fox says. “You should screen for vascular risk factors and treat them accordingly.”

He also pointed to the potential benefits of seizure treatment.

“For future research, the biggest question I have is whether or not treatment of functional seizures decreases the risk for complications such as death,” Dr. Fox says. “I also want to know if treatment of functional seizures ultimately leads to an improvement in vascular risk factors.”

Key Takeaways

• Hypertension, obesity, and hyperlipidemia are clinical vascular characteristics that are elevated in patients with functional seizures
• These factors may contribute to the development of cerebrovascular and cardiovascular disease, as well as mortality
• Neurologists should screen for these conditions in patients with seizures and aim to manage them as part of a patient’s overall treatment