Vanderbilt University Medical Center researchers used electronic medical record data to determine the prevalence of “functional seizures” and the comorbidities associated with them.
In a study published this past week in the Journal of the American Medical Association, the team found that post-traumatic stress disorders and sexual assault trauma were associated with functional seizures, or episodes that are similar to epileptic seizures in their clinical presentation but display no aberrant brain electrical patterns. Functional seizure patients face an average diagnostic delay of seven years.
“I felt like studies within electronic health records could potentially be really impactful for this community,” said Lea Davis, who headed the team, to the VUMC Reporter.
WHY IT MATTERS
Using a database of deidentified EHR data from VUMC, researchers developed a clinically validated phenotyping algorithm to identify functional seizures cases; estimated the period prevalence of functional seizures in a hospital population; and identified comorbidities associated with functional seizures.
The study population included more than 2 million VUMC patients from 1994 to 2019, with the team extracting demographic characteristics, ICD-9 and ICD-10 codes, CPT codes and clinical notes from the EHR and mining them for analyses.
“Based on the number of patients identified by our algorithm in proportion to the total number of patients in our hospital system, we calculated the period prevalence of functional seizures to be 0.14% in our clinical population,” wrote researchers.
The team found evidence supporting existing reports that functional seizures co-occur with psychiatric and neurological disorders.
In addition, patients with functional seizures are nearly 16 times more likely than the average hospital patient to have a documented history of sexual assault trauma—and that such trauma explains 22% of the increased rate of functional seizures in women.
The results suggest that functional seizure patients are at risk for additional chronic health conditions, including cerebrovascular disease.
“However, we observed no clear illness trajectory from functional seizures to cerebrovascular disease, and in fact found that cerebrovascular disease often preceded the onset of functional seizures,” researchers noted. “These findings have important implications for the management of patients who develop post stroke seizures.”
THE LARGER TREND
Given the large volumes of information available in EHRs, researchers and software companies have developed new tools for more easily extracting data.
For instance, researchers from the University of Michigan last year developed an open-source framework that streamlines the preprocessing of EHR data.
“By accelerating and standardizing the labor-intensive preprocessing steps, FIDDLE can help stimulate progress in building clinically useful [machine learning] tools,” wrote those researchers.
ON THE RECORD
“Overall, we believe that this novel EHR-based study provides important rationale and motivation for ongoing EHR-based research to improve the complex and challenging clinical care of patients with functional seizures,” said the VUMC team.