Cognition is a core component of functional seizures, but the literature on cognition in this disorder has been heterogeneous, with no clear unifying profile emerging from individual studies. The aim of this study was to do a systematic review and meta-analysis of cognitive performance in adults with functional seizures compared with epilepsy (including left temporal lobe epilepsy) and compared with healthy non-seizure cohorts. In this systematic review and meta-analysis, starting Feb 6, 2023, replicated and updated on Oct 31, 2023, a medical librarian searched MEDLINE, Embase, PsycINFO, and Web of Science. Inclusion criteria were full reports documenting raw or standardised cognitive test data in adults with functional seizures compared with adults with epilepsy, prospectively recruited healthy comparisons, or published norms. Grey literature was retained and there were no language or date restrictions. We excluded studies only reporting on mixed functional seizures and epilepsy, or mixed functional neurological samples, with no pure functional seizures group. Risk of bias was evaluated using a modified version of the Newcastle–Ottawa Scale. People with lived experiences were not involved in the design or execution of this study. This study is registered as CRD42023392385 in PROSPERO. Of 3834 records initially identified, 84 articles were retained, including 8654 participants (functional seizures 4193, epilepsy 3638, and healthy comparisons 823). Mean age was 36 years (SD 12) for functional seizures, 36 years (12) for epilepsy, and 34 years (10) for healthy comparisons, and the proportion of women per group was 72% (range 18–100) for functional seizures, 59% (range 15–100) for epilepsy, and 69% (range 34–100) for healthy comparisons. Data on race or ethnicity were rarely reported in the individual studies. Risk of bias was moderate. Cognitive performance was better in people with functional seizures than those with epilepsy (Hedges’ g=0·17 [95% CI 0·10–0·25)], p<0·0001), with moderate-to-high heterogeneity (Q[56]=128·91, p=0·0001, =57%). The functional seizures group performed better than the epilepsy group on global cognition and intelligence quotient (g=0·15 [0·02–0·28], p=0·022) and language (g=0·28 [0·14–0·43], p=0·0001), but not other cognitive domains. A larger effect was noted in language tests when comparing functional seizures with left temporal lobe epilepsy (k=5; g=0·51 [0·10 to 0·91], p=0·015). The functional seizures group underperformed relative to healthy comparisons (g=−0·61 [−0·78 to −0·44], p<0·0001), with significant differences in all cognitive domains. Meta regressions examining effects of multiple covariates on global cognition were not significant. Patients with functional seizures have widespread cognitive impairments that are likely to be clinically meaningful on the basis of moderate effect sizes in multiple domains. These deficits might be slightly less severe than those seen in many patients with epilepsy but nevertheless argue for consideration of clinical assessment and treatment. Department of Veterans Affairs, Veterans Health Administration.

中文翻译：

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与癫痫和健康对照相比，功能性癫痫发作的认知表现：系统评价和荟萃分析


认知是功能性癫痫发作的核心组成部分，但有关这种疾病认知的文献多种多样​​，个别研究中没有出现明确的统一概况。本研究的目的是对患有功能性癫痫发作的成人与癫痫（包括左颞叶癫痫）以及健康非癫痫队列的认知表现进行系统回顾和荟萃分析。在这项从 2023 年 2 月 6 日开始并于 2023 年 10 月 31 日重复和更新的系统综述和荟萃分析中，一位医学图书馆员搜索了 MEDLINE、Embase、PsycINFO 和 Web of Science。纳入标准是记录功能性癫痫成人与癫痫成人的原始或标准化认知测试数据的完整报告、前瞻性招募的健康比较或已发布的标准。灰色文献被保留，没有语言或日期限制。我们排除了仅报告混合功能性癫痫发作和癫痫或混合功能性神经学样本的研究，没有纯功能性癫痫组。使用纽卡斯尔-渥太华量表的修改版本来评估偏倚风险。有生活经验的人没有参与这项研究的设计或执行。该研究在 PROSPERO 中注册为 CRD42023392385。在最初确定的 3834 条记录中，保留了 84 篇文章，其中包括 8654 名参与者（功能性癫痫 4193 例，癫痫 3638 例，健康对照 823 例）。功能性癫痫发作的平均年龄为 36 岁 (SD 12)，癫痫的平均年龄为 36 岁 (12)，健康比较的平均年龄为 34 岁 (10)，功能性癫痫发作的每组女性比例为 72%（范围 18-100） ，59%（范围 15-100）用于癫痫，69%（范围 34-100）用于健康比较。 个别研究中很少报告有关种族或族裔的数据。偏倚风险为中等。功能性癫痫发作患者的认知表现优于癫痫患者（Hedges' g=0·17 [95% CI 0·10–0·25)]，p<0·0001），具有中度至高度异质性（ Q[56]=128·91，p=0·0001，=57%）。功能性癫痫组在整体认知和智商（g=0·15 [0·02–0·28]，p=0·022）和语言（g=0·28 [0·14）方面表现优于癫痫组–0·43]，p=0·0001），但其他认知领域则不然。当将功能性癫痫发作与左颞叶癫痫进行比较时，在语言测试中发现了更大的影响（k=5；g=0·51 [0·10 至 0·91]，p=0·015）。相对于健康组，功能性癫痫发作组表现不佳（g=-0·61 [-0·78 至 -0·44]，p<0·0001），所有认知领域均存在显着差异。检查多个协变量对整体认知影响的荟萃回归并不显着。功能性癫痫患者具有广泛的认知障碍，基于多个领域的中等效应大小，这些障碍可能具有临床意义。这些缺陷可能比许多癫痫患者所见的缺陷稍轻，但仍然需要考虑临床评估和治疗。退伍军人事务部、退伍军人健康管理局。