MRI shows brain structural changes associated with functional, non-epileptic seizures

More than 3 million Americans have epilepsy, which causes seizures due to abnormal electrical activity in the brain.

Some people have seizures that are not caused by epilepsy. It is known by various names such as functional seizures, psychogenic seizures, non-epileptic seizures, and pseudo-seizures. Scientists have long understood this as the body’s response to mental stressors such as anxiety and post-traumatic stress disorder. I discovered that it is related to structural changes in the brain that can

A team of researchers, led by Michigan Medicine, analyzed more than 650 clinical-grade MRI images of patients with functional seizures and other psychiatric disorders such as depression and anxiety who had not experienced seizures. We compared images of potentially healthy patients.

results published in Epilepsy and behavior Patients with functional seizures have a thinning of the superior temporal cortex, which affects a person’s cognitive awareness and control of behavior, and a thinning of the left occipital cortex, which is responsible for processing visual and other sensory information. It became clear. These changes were not seen in people with depression, anxiety, or obsessive-compulsive disorder (OCD).

If we can figure out what brain changes cause people to have functional seizures, we can start looking at ways to reverse them.”

Wesley Kerr, MD, Ph.D., first author, neurologist and epileptologist, University of Michigan Health

“Currently, the treatment for functional seizures is cognitive-behavioral information therapy, but this treatment does not work for everyone. We want to find new ways to do it.”

Misdiagnosis of epilepsy

One of the challenges in treating functional seizures is early identification of functional seizures. Most patients with functional seizures are treated for epilepsy for an average of nine years before being correctly diagnosed.

That misdiagnosis can do real harm to patients, says Kerr, a clinical instructor in neurology at UM Medical School. In the future, this type of structural MRI may reveal biomarkers that distinguish between the two conditions.

“In the years before people were correctly diagnosed with functional seizures, 80% of people were prescribed anti-seizure medications used to treat epilepsy.” “These people may come to the ER with prolonged seizures, be intubated, and be given high doses of medication. They are at risk for functional seizures.”

psychotherapy Used as a treatment for functional seizures, it addresses the underlying psychological stressors that overflow and cause symptoms.

Distinguishing between epileptic and non-epileptic seizures

Although there are clear markers of electrical abnormalities in epilepsy, distinguishing between the condition and functional seizures is not straightforward. Clinicians diagnose epilepsy based on the number and type of seizures a patient experiences and diagnostic tests. If the seizure is epileptic, not acting quickly can cause permanent brain damage or death.

“In those cases, people tend to give high doses of seizure medication when they’re not sure,” Carr said. 10% actually have prolonged functional seizures.”

A health care provider can obtain an electroencephalogram (EEG), which picks up electrical signals in the brain after hearing or observing a seizure. However, about half of people with known focal epilepsy have normal EEG readings.

“We always want to have EEG and MRI information to corroborate what we see clinically in patients, but we need to see seizures to definitively diagnose functional seizures,” says Kerr. said Mr.

“But once diagnosed with functional seizures, the high cost they have is due to frequent visits to the ER and having to pay a lot for anticonvulsant drugs to improve their quality of life.” It can reduce health care utilization.Early diagnose people with functional seizures.”

As researchers continue to explore structural differences in changes to the brain between functional seizures and epilepsy, MRI will continue to play an important role in improving the diagnosis and treatment of both conditions.

“We know that early and accurate diagnosis of functional seizures is essential to initiating treatment that improves quality of life.” psychiatry at UM Medical School.

“This study is an example of how we can look more closely at the tests we already have, such as standard MRIs of the brain, for subtle clues that lead to a correct diagnosis. We look forward to seeing how it improves the speed and accuracy of diagnostics so that we can bring patients with functional seizures to the right treatment sooner.”