Prevalence of stressful life events in young people with functional seizures: A systematic review and narrative synthesis

BACKGROUND: Functional seizures are episodes resembling epileptic seizures without abnormal electrical activity. Stressful life events (SLEs) may act as contextual or vulnerability factors in adults, but their relevance in children is unclear. This review summarises the types and prevalence of SLEs in young people with functional seizures and, where possible, compares findings with healthy peers and those with epilepsy. METHODS: PsycINFO, MEDLINE, and Web of Science were searched to October 2024. Studies were included if participants were under 18, had a v-EEG-confirmed or ILAE-defined diagnosis of functional seizures, and reported SLEs with extractable child-specific data. Twenty-one studies met inclusion criteria. SLEs were grouped into six inductively derived categories. Study quality and risk of bias were assessed using the Joanna Briggs Institute framework. Findings were synthesised narratively due to heterogeneity. RESULTS: A variety of SLEs were reported, but measurement approaches and sample characteristics varied. Some studies suggested higher SLE rates in functional seizure populations compared to healthy or epilepsy controls, and several reported greater exposures among adolescents than younger children. Few studies controlled for confounders. CONCLUSIONS: SLEs may represent one of several contextual or vulnerability factors for some young people with functional seizures, rather than a defining or causal feature. Evidence is limited by inconsistent measurement and study design. Future research using standardised SLE assessments, diverse samples, and controlled or longitudinal designs is needed to clarify the role of life stress within biopsychosocial formulations and clinical care.