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Abstract: Objective: Several studies have found that people with functional seizures (FS) have increased mortality, approaching that of epilepsy (epileptic seizures [ES]). The small numbers of deaths in these studies make it unclear whether they can be attributed to comorbidities. We used a very large electronic health database to compare mortality in FS and ES, controlling for comorbidity. Methods: We searched the TriNetX database for people with FS and no ES, people with ES and no FS, and people with neither FS nor ES (NS). We compared mortality while controlling for demographics and comorbid conditions. Results: We identified 1 916 787 people with ES, 32 854 people with FS, and 21 053 667 healthy controls. FS had rates of mental and physical comorbidities that were higher than NS and, for most categories, higher than ES. The risk of death (hazard ratio [HR]) in ES compared to FS was 2.99 (95% confidence interval [CI] = 2.81-3.18), which was reduced to 2.07 (95% CI = 1.92-2.24) when matched for 31 demographic and health factors. The risk of death in NS compared to FS was .56 (95% CI = .53-.59); after matching for demographics and mood disorders, this was .48 (95% CI = .44-.53). Matched sensitivity analyses suggest this was particularly pronounced in the year following diagnosis (HR = .39, 95% CI = .33-.47) and in the 5th decade of life (HR = .38, 95% CI = .27-.52). Significance: FS confers approximately doubled mortality over that conferred by its comorbidities, although still only half of that conferred by ES, most prominently after diagnosis and in early middle age.
Keywords: etiology, functional neurological disorder, mechanism, nasology
Published in DiRROS: 27.07.2026; Views: 179; Downloads: 157
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Abstract: Background: Adverse life events and other stressors were central to historical 'Freudian' models of functional neurological disorder (FND), which have been increasingly replaced by more nuanced biopsychosocial models. Studies of the aetiological relevance of stressors have been limited by small sample sizes. Methods: Retrospective cohort analyses using a large international electronic health records network (TriNetX), including ICD-10 codes, were performed. Between 2015 and 2025, 147,595 individuals were diagnosed with FND. The rates of adverse life events and psychosocial stressors were compared to matched cohorts with migraine and generalised anxiety disorder (GAD) diagnoses. We also investigated associations between FND and the presence of stressors, including the stressor type and whether it occurred in childhood or adulthood. Findings: Rates of abuse or neglect (1·33%), assault (2·42%), and psychosocial and socioeconomic difficulties (10·63%) were significantly higher in FND compared to migraine (0·42%/0·93%/3·43%, respectively) and GAD (0·75%/1·29%/7·69%, respectively) (p < ·0001 for all comparisons). A history of physical and sexual abuse was more prevalent in FND than in comparison groups. Psychological abuse was more common in FND than in migraine, but not when compared to GAD. FND cases with recorded stressors were younger, more often female, and more frequently diagnosed with functional/dissociative seizures than those without stressors. Further, these stressors were associated with an increased prevalence of psychiatric comorbidities, pain, and fatigue. Different stressor types had distinct influences on clinical presentations. Adult-onset adversity was associated with higher rates of psychiatric comorbidities, pain and fatigue. Interpretation: A record of adversities was at least 2·5 times more common in FND than in migraine, and about 1·5 times more common than in GAD, varying by stressor type. Psychosocial stressors were particularly common. The presence of stressors, as well as their type, shapes the presentation of FND. Life history should therefore be considered when assessing individuals with FND.
Keywords: conversion disorder, FND, functional neurological disorder, life events, stress, trauma
Published in DiRROS: 10.04.2026; Views: 388; Downloads: 327
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Abstract: Parkinson’s disease (PD) is a neurological disorder characterized by rigidity, bradykinesia and tremor. Several genetic and environmental causes of PD are known, and there is emerging evidence of the possible contribution of the gut microbiome to the disease onset, severity, and response to therapy. While previous research has shown several differences in the microbiome of PD patients under therapy as opposed to healthy controls, few prospective studies have included drug-naïve patients. In order to evaluate the gut microbiome composition prior to therapy initiation, we collected and performed 16S rRNA gene sequencing of the stool samples from 49 drug-naïve PD patients and compared them to 34 diet and lifestyle-matched controls from the Croatian population (GiOPARK Project). While no significant alpha diversity difference was observed between the patients and controls, the differential relative abundance analysis showed an increase in Bacteroides fluxus, B. interstinalis, B. eggerthii, and Dielma fastidiosa in the drug-naïve PD patients compared to controls, while Alistipes, Barnesiella and Dialister spp. were decreased in patients compared to controls. Despite preserved overall diversity, these changes may indicate early microbial dysbiosis and represent a foundation for future studies exploring microbiome changes across disease progression and treatment.
Keywords: Parkinson’s disease, neurological disorder, gut microbiome, microbial diversity, microbial dysbiosis
Published in DiRROS: 23.02.2026; Views: 648; Downloads: 305
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