Development of De novo Functional Seizures after Epilepsy Surgery
Merlin Manoj1, Mahinda Yogarajah1, Shehroz Huda1, Jane De Tisi2, John Duncan3
1National Hospital for Neurology and Neurosurgery, 2UCL, 3National Hospital for Nervous
Objective:

The purpose of this evaluation was to identify the frequency and risk factors of de novo FS in patient after epilepsy surgery.

Background:

Functional seizures (FS) (also known as psychogenic non-epileptic seizures (PNES) or dissociative seizures) are seizures that mimic an epileptic seizure but have no associated epileptogenic EEG changes and are thought to have a psychological basis. Epilepsy surgery can be an effective means of treatment for patients with drug refractory seizures, but it is important to understand the complications that can arise from surgery.

 

Design/Methods:
The surgical data based showed 1116 patients who underwent epilepsy surgery from 1998 to 2022. The clinic notes were reviewed and identified 37 patients who developed de novo FS post-surgery. They were characterised by their age, sex, age of surgery, duration of epilepsy before surgery, pre-operative psychiatric co- morbidities, type/site of surgery, and post-operative complications
Results:

37 patients were identified (30F, 7M). The mean age at the time of surgery was 36.2 (17-52 years). 31 patients had documented post-operative de novo FS. 16 patients had a documented pre-operative psychiatric diagnosis. 10 patients developed immediate post-operative complications and de novo FS an average of 9.8 months after surgery. 4 patients with no past psychiatric issues developed psychosis following immediate post-operative complications.  Patient with no immediate post-operative complications with or without pre-operative psychiatric diagnosis developed de novo FS on average of 29.4 months after epilepsy surgery

Conclusions:
: 1) The rate of development of de novo FS after epilepsy surgery is low (2.77%). 2) The patients who have de novo FS after surgery have high rates of pre-operative psychiatric diagnoses (43.2 %), are predominantly female (81.1%) , and have immediate post-op complications (27%). 3) Immediate post-operative complications can result in new functional seizures developing less a year after surgery
10.1212/WNL.0000000000203241