Pregnancy outcomes and changes to seizure frequency during pregnancy for patients with functional seizures

Purpose: The goal of this study was to determine the relative frequency of functional seizures (FS) with respect to pregnancy and to document pregnancy outcomes of patients with FS. Pregnancy can be a stressful period in a woman's life and may contribute to FS in childbearing patients. Methods: A retrospective chart review was conducted on pregnant patients admitted to Magee Women's Hospital at the University of Pittsburgh Medical center from January 2015 to July 2024. We describe the characteristics of patients with FS with and without co-occurring epilepsy. Potential comorbid associated factors for FS were documented along with gestational age at delivery, obstetrical complications, mode of delivery and fetal outcome. Results: This analysis included 29 patients (18 with FS only, and 11 with comorbid FS and Epilepsy) for a total of 45 pregnancies. The diagnosis of FS was made prior to pregnancy in 12 patients (41%), during pregnancy in 13 patients (44%), and after pregnancy in 4 (14%). FS frequency worsened during pregnancy in 50% (6/12) of patients diagnosed before pregnancy, in 75% (3/4) of those diagnosed after pregnancy, and occurred de novo in 13 patients diagnosed during pregnancy. FS frequency improved during pregnancy in 17% (2/12) of patients with diagnosis before pregnancy and none diagnosed after pregnancy (0/4). Cesarean section rate was 68%. The rates of multiple maternal and neonatal complications were high. Conclusions: In this cohort, FS often worsened or started during pregnancy raising concern for possible maladaptation to the stresses of the parous state. To reduce seizure frequency, and improve neonatal and maternal outcomes, prompt diagnosis of FS is needed to address modifiable factors. Epilepsy and FS are not indications for cesarean section. The high rate of cesarean section noted in both of these disorders with its inherent surgical risk highlights the need for recognition of this disorder and multidisciplinary collaboration prior to delivery.