Negative impact of self-reported executive problems in patients with functional/dissociative seizures: Results from a prospective long-term observational study

Abstract

Objective: Functional/dissociative seizures (FDS) are common and pose a considerable burden on both individual patients and healthcare systems. Cognitive complaints are frequent in patients with FDS. Previous studies on cognitive function in patients with FDS have yielded mixed results. We investigated executive function and its impact on long-term outcome in a prospective sample of patients with FDS.

Methods: Thirty-three inpatients (age range: 16-62 years) who had been admitted to the National Centre for Epilepsy in Norway with FDS underwent neuropsychological assessment for both tested and self-reported executive function, using the Behavior Rating Inventory of Executive Function, at baseline. Participants were evaluated for their medical status at a mean of 5.5 years (SD 2.4, range 1.9-10.9 years) after inclusion. To determine potential predictors of achieving cessation of FDS by time of follow-up a multivariate logistic regression analysis was conducted.

Results: At follow-up, 14/33 (42 %) of the participants were FDS-free. Self-reported, but not tested, executive dysfunction was an independent risk factor for ongoing FDS at follow-up.

Conclusion: Our findings indicate an association between greater self-reported executive problems and poorer long term outcomes in patients with FDS. Screening for executive dysfunction with a self-report questionnaire may yield relevant information that could be used to guide psychological interventions.

Keywords: Cognition; Executive function; Functional neurological disorder; Functional/dissociative seizures; Neuropsychology; Psychogenic nonepileptic seizures.