Abstracts

Rationale: Research has produced inconsistent findings for patients with PNES compared to patients with epilepsy regarding mood and anxiety symptoms. Some research has demonstrated significantly higher levels of depression and anxiety in patients with PNES compared to epilepsy. Limited research has examined reported levels of anxiety at the time of evaluation which can influence performance during a neuropsychological evaluation. This study compared measures of anxiety as well as depression in both groups. Furthermore, it tested comparisons between percentages scoring at clinical levels on these measures. We hypothesized that patients with PNES would score significantly higher than those with epilepsy on measures of anxiety and depression. We also hypothesized that a significantly higher percentage of patients with PNES would would present with clinical level scores than patients with epilepsy.

Methods: Patients treated between 2020 and 2025 were included.  Diagnoses were confirmed through VEEG testing. Exclusion criteria: 1) dual PNES and epilepsy diagnosis; and 2) younger than 18 years. Neuropsychological testing records including the State Trait Anxiety Inventory and the Center for Epidemiological Studies - Depression Scale (CES-D) were reviewed. A total of 77 patients with PNES and 91 with epilepsy were included.   Group means were examined using t-scores.    T scores of 60 and above were deemed clinically significant scores for STAI T scores. Raw scores on the CES-D that were more than or equal to 16 were considered clinically significant.    Comparisons of percentages of patients demonstrating clinical levels were compared using chi-square analysis.

Results: Significant differences were observed between means on all measures: STAI-State raw score (p=.015), STAI-State T score (p=.027), STAI-Trait raw score (p< .001), STAT-Trait T score (p,.001) and CES-D raw score (p=.003). A significant difference was found for the group percentage demonstrating scores at clinical levels for STAI-Trait (p< .05). No significant differences were found for percentage of group demonstrating scores at clinical levels for STAI-State (p=.101176) or CES-D (p=.186992).

Conclusions: Findings revealed significantly higher scores on measures of anxiety as well as depression in patients with PNES compared to those with epilepsy. Findings also demonstrated that a relatively comparable number of patients in both groups experienced anxiety at the time of testing. Therefore, it would seem that the potential impact of anxiety during testing in patients with PNES is not higher than in patients with epilepsy. In sum, this study revealed that patients with PNES present with higher levels of depression than those with epilepsy. They also present with higher scores on state and trait anxiety measures as compared to those with epilepsy. This higher level of anxiety at the time of testing suggests that particular attention should be given to making these patients feel safe and given clear information regarding what to expect during testing and from results. Both patient groups would likely benefit from a therapy referral.

Funding: Supported by Ministry of Health of the Czech Republic, grant MH CZ and DRO (NHH, 193001) IG193001 and IG223001.