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Kerr WT, Patterson EH, O'Sullivan IM, Horbatch FJ, Darpel KA, Patel PS, Robinson-Mayer N, Winder GS, Beimer NJ. Elevated Mortality Rate in Patients With Functional Seizures After Diagnosis and Referral. Neurol Clin Pract 2024; 14:e200227. [PMID: 38223352 PMCID: PMC10783975 DOI: 10.1212/cpj.0000000000200227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/03/2023] [Indexed: 01/16/2024]
Abstract
Background and Objectives To evaluate the standardized mortality ratio (SMR) of patients in the United States referred to a multidisciplinary clinic for treatment of functional seizures. Methods We identified patients who had or had not died based on automated retrospective review of electronic health records from a registry of patients referred to a single-center multidisciplinary functional seizures treatment clinic. We calculated an SMR by comparing the number of observed deaths with the expected number of deaths in an age-matched, sex-matched, and race-matched population within the same state, and year records were available. Results A total of 700 patients with functional seizures (mean age 37 years, 78% female) were followed up for 1,329 patient-years for a median of 15 months per patient (interquartile range 6-37 months). We observed 11 deaths, corresponding to a mortality rate of 8.2 per 1,000 patient-years and an SMR of 2.4 (95% confidence interval: 1.17-4.22). Five of 9 patients with identified circumstances around their death were in hospice care when they passed. None of the identified causes of death were related to seizures directly. Discussion These data provide further evidence of elevated mortality in functional seizures soon after diagnosis and referral to treatment. These data from the decentralized health care system of the United States build on the findings from other countries with large-scale health registries.
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Affiliation(s)
- Wesley T Kerr
- Departments of Neurology and Biomedical Informatics (WTK), University of Pittsburgh, PA; Department of Neurology (WTK, EHP, IMO, FJH, KAD, PSP, NR-M, GSW, NJB); Department of Psychiatry (EHP, GSW, NJB), University of Michigan, Ann Arbor; Department of Neurology (KAD), St. Elizabeth Medical Center, Fort Thomas; Department of Neurology (KAD), Hazard Appalachian Regional Health, Hazard, KY; Department of Neurology (PSP), John F. Kennedy University Medical Center, Edison; Departments of Neurology and Psychiatry (PSP), Hackensack Meridian School of Medicine, Nutley, NJ; Department of Social Work (NR-M); and Department of Surgery (GSW), University of Michigan, Ann Arbor, MI
| | - Elissa H Patterson
- Departments of Neurology and Biomedical Informatics (WTK), University of Pittsburgh, PA; Department of Neurology (WTK, EHP, IMO, FJH, KAD, PSP, NR-M, GSW, NJB); Department of Psychiatry (EHP, GSW, NJB), University of Michigan, Ann Arbor; Department of Neurology (KAD), St. Elizabeth Medical Center, Fort Thomas; Department of Neurology (KAD), Hazard Appalachian Regional Health, Hazard, KY; Department of Neurology (PSP), John F. Kennedy University Medical Center, Edison; Departments of Neurology and Psychiatry (PSP), Hackensack Meridian School of Medicine, Nutley, NJ; Department of Social Work (NR-M); and Department of Surgery (GSW), University of Michigan, Ann Arbor, MI
| | - Isabel M O'Sullivan
- Departments of Neurology and Biomedical Informatics (WTK), University of Pittsburgh, PA; Department of Neurology (WTK, EHP, IMO, FJH, KAD, PSP, NR-M, GSW, NJB); Department of Psychiatry (EHP, GSW, NJB), University of Michigan, Ann Arbor; Department of Neurology (KAD), St. Elizabeth Medical Center, Fort Thomas; Department of Neurology (KAD), Hazard Appalachian Regional Health, Hazard, KY; Department of Neurology (PSP), John F. Kennedy University Medical Center, Edison; Departments of Neurology and Psychiatry (PSP), Hackensack Meridian School of Medicine, Nutley, NJ; Department of Social Work (NR-M); and Department of Surgery (GSW), University of Michigan, Ann Arbor, MI
| | - Faith J Horbatch
- Departments of Neurology and Biomedical Informatics (WTK), University of Pittsburgh, PA; Department of Neurology (WTK, EHP, IMO, FJH, KAD, PSP, NR-M, GSW, NJB); Department of Psychiatry (EHP, GSW, NJB), University of Michigan, Ann Arbor; Department of Neurology (KAD), St. Elizabeth Medical Center, Fort Thomas; Department of Neurology (KAD), Hazard Appalachian Regional Health, Hazard, KY; Department of Neurology (PSP), John F. Kennedy University Medical Center, Edison; Departments of Neurology and Psychiatry (PSP), Hackensack Meridian School of Medicine, Nutley, NJ; Department of Social Work (NR-M); and Department of Surgery (GSW), University of Michigan, Ann Arbor, MI
| | - Kyle A Darpel
- Departments of Neurology and Biomedical Informatics (WTK), University of Pittsburgh, PA; Department of Neurology (WTK, EHP, IMO, FJH, KAD, PSP, NR-M, GSW, NJB); Department of Psychiatry (EHP, GSW, NJB), University of Michigan, Ann Arbor; Department of Neurology (KAD), St. Elizabeth Medical Center, Fort Thomas; Department of Neurology (KAD), Hazard Appalachian Regional Health, Hazard, KY; Department of Neurology (PSP), John F. Kennedy University Medical Center, Edison; Departments of Neurology and Psychiatry (PSP), Hackensack Meridian School of Medicine, Nutley, NJ; Department of Social Work (NR-M); and Department of Surgery (GSW), University of Michigan, Ann Arbor, MI
| | - Palak S Patel
- Departments of Neurology and Biomedical Informatics (WTK), University of Pittsburgh, PA; Department of Neurology (WTK, EHP, IMO, FJH, KAD, PSP, NR-M, GSW, NJB); Department of Psychiatry (EHP, GSW, NJB), University of Michigan, Ann Arbor; Department of Neurology (KAD), St. Elizabeth Medical Center, Fort Thomas; Department of Neurology (KAD), Hazard Appalachian Regional Health, Hazard, KY; Department of Neurology (PSP), John F. Kennedy University Medical Center, Edison; Departments of Neurology and Psychiatry (PSP), Hackensack Meridian School of Medicine, Nutley, NJ; Department of Social Work (NR-M); and Department of Surgery (GSW), University of Michigan, Ann Arbor, MI
| | - Najda Robinson-Mayer
- Departments of Neurology and Biomedical Informatics (WTK), University of Pittsburgh, PA; Department of Neurology (WTK, EHP, IMO, FJH, KAD, PSP, NR-M, GSW, NJB); Department of Psychiatry (EHP, GSW, NJB), University of Michigan, Ann Arbor; Department of Neurology (KAD), St. Elizabeth Medical Center, Fort Thomas; Department of Neurology (KAD), Hazard Appalachian Regional Health, Hazard, KY; Department of Neurology (PSP), John F. Kennedy University Medical Center, Edison; Departments of Neurology and Psychiatry (PSP), Hackensack Meridian School of Medicine, Nutley, NJ; Department of Social Work (NR-M); and Department of Surgery (GSW), University of Michigan, Ann Arbor, MI
| | - Gerald S Winder
- Departments of Neurology and Biomedical Informatics (WTK), University of Pittsburgh, PA; Department of Neurology (WTK, EHP, IMO, FJH, KAD, PSP, NR-M, GSW, NJB); Department of Psychiatry (EHP, GSW, NJB), University of Michigan, Ann Arbor; Department of Neurology (KAD), St. Elizabeth Medical Center, Fort Thomas; Department of Neurology (KAD), Hazard Appalachian Regional Health, Hazard, KY; Department of Neurology (PSP), John F. Kennedy University Medical Center, Edison; Departments of Neurology and Psychiatry (PSP), Hackensack Meridian School of Medicine, Nutley, NJ; Department of Social Work (NR-M); and Department of Surgery (GSW), University of Michigan, Ann Arbor, MI
| | - Nicholas J Beimer
- Departments of Neurology and Biomedical Informatics (WTK), University of Pittsburgh, PA; Department of Neurology (WTK, EHP, IMO, FJH, KAD, PSP, NR-M, GSW, NJB); Department of Psychiatry (EHP, GSW, NJB), University of Michigan, Ann Arbor; Department of Neurology (KAD), St. Elizabeth Medical Center, Fort Thomas; Department of Neurology (KAD), Hazard Appalachian Regional Health, Hazard, KY; Department of Neurology (PSP), John F. Kennedy University Medical Center, Edison; Departments of Neurology and Psychiatry (PSP), Hackensack Meridian School of Medicine, Nutley, NJ; Department of Social Work (NR-M); and Department of Surgery (GSW), University of Michigan, Ann Arbor, MI
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