Prevalence and risk factors of functional seizures among adult Sudanese patients with epilepsy, a cross-sectional clinic-based study

Background: Epilepsy can be associated with functional seizures. Our main aim is to assess functional seizures' prevalence and risk factors among adult Sudanese patients with epilepsy.Methods: This cross-sectional clinic-based study was conducted from January to February 2021 at Daoud Charity Clinic in Omdurman city, Sudan. Ninety-nine adult Sudanese patients with epilepsy were included. Data were collected using a validated interview-based semi-structured questionnaire. A senior consultant neurologist and a consultant psychiatrist diagnosed the functional seizures based on full clinical history and investigations. The diagnosis was performed according to International League against epilepsy (ILAE) classification.Results: This study included 99 patients with epilepsy, 57% were females, 79% reside in Khartoum state, and 32% reached secondary school. The main types of epilepsy were generalized tonic-clonic (68%), followed by focal seizures with impaired awareness (11%). The majority of the patients have been diagnosed with epilepsy for over three years (65%). Comorbid epilepsy and functional seizures were found in 29% of the patients, with a significantly higher prevalence in patients with social problems and depression (p = 0.005 and p < 0.01, respectively). Patients with depression had a 14 times higher risk of functional seizures than those without depression, 95% CI [3.8, 52.3].Conclusion: A remarkably high prevalence of functional seizures was found among adult patients with epilepsy. Patients suffering from social problems and/or depression and poor economic status had a higher tendency to develop functional seizures, especially after two to three years of treatment and above.