Abstract
BACKGROUND: Prior research has revealed that chronic migraine is among the most commonly reported coexisting conditions in people with functional seizures (FS). We questioned whether migraine treatment affects FS frequency in these patients. METHODS: We selected patients with chronic migraine and FS. Patients received no treatment in the initial 3 months (observation period), followed by two injections of botulinumtoxin type A (BT-A) in the fourth and seventh months, and were followed up for six months in the treatment period. Patient records on headache days and FS counts were analyzed using multilevel Poisson regression. The authors also conducted a mediation analysis. RESULTS: Overall, 30 patients completed 9 months follow-up period. The median age of the participants was 29 years (IQR: 24-37 years), with a female predominance (93.3%). The number of headache days and FS counts decreased with treatment 48.52% (95% CI: 41.68% to 54.55%) and 80.61% (69.51%-87.67%), respectively. Regression analyses revealed that treatment reduced the number of headache days by 8.58 (95% CI, 6.97-10.2, p < 0.001) and FS counts by 3.58 (95% CI, 2.33-4.83, p < 0.001) relative to the observation period. A within-participant mediation analysis revealed an indirect treatment effect on FS (2.62, 95% CI: 0.74-4.57). CONCLUSION: Migraine treatment may decrease FS counts in patients with FS. Further research is needed to assess the causal relationship between migraine attacks and FS. If confirmed in future studies, our findings underscore the importance of migraine screening and treatment in patients with FS.