Abstracts

Rationale: Prior research on PNES has focused on alexithymia – difficulties recognizing, identifying, and communicating emotional states and has found patients with PNES have more difficulties in this area than those with epilepsy. With the exception of one study, most research has focused on the overall score rather than the sub-measures of difficulties identifying and describing emotions and external thinking. When differences on the sub-measures among those with epileptic and non-epileptic seizures and controls were examined, a significant difference was seen between the groups on the difficulty describing feelings sub-measure but not the other two. This was lost after controlling for anxiety. It is worth replicating this study, given the potential role that alexithymia has on treatment of PNES. This study examined differences between patients with epilepsy and those with PNES on these sub-scores.

Methods: This is a retrospective study of 16 patients (7 female, 9 male) diagnosed with epilepsy and 23 patients (20 female, 3 male) diagnosed with PNES. The diagnosis was confirmed with video EEG. All patients were administered the Toronto Alexithymia Scale during a comprehensive neuropsychological evaluation. Means of the two groups were compared using a one-way ANOVA. Means were then compared with co-variates (measures of depression and anxiety) using ANCOVAs. Differences in proportions between groups were compared with independent samples proportions tests. Statistics were done with IBM SPSS Version 28.0.1.1.

Results: Significant differences were seen on three measures of alexithymia: overall score, difficulty identifying, and difficulty describing. ANCOVAs controlling for depression and anxiety removed the main effect for group for the overall score and the two sub-indices. For each, measures of depression and anxiety were significant covariates. Significant differences were seen between the groups on measures of depression and anxiety.  Significant or near significant differences in proportion between groups were seen for those at or above the cut off for alexithymia as well as particular cut offs for difficulties identifying and describing emotions.

Conclusions: Significant differences were seen when comparing means on measures of alexithymia as well as specific difficulties identifying and describing emotions. This is consistent with prior studies. However, these differences were not significant when depression and anxiety were controlled, which is also consistent with prior research. While alexithymia scores may not be helpful in distinguishing between the two groups, it should be noted that a greater proportion of patients with PNES were at or above the cutoff for alexithymia than those with ES, suggesting that it may indeed play an important role in PNES. Likewise, greater proportions demonstrated difficulties identifying and describing emotions. This is in the context of higher levels of depression and anxiety symptoms. These findings suggest a subgroup within PNES with alexithymia, depression, and anxiety which may require a different treatment approach focused on developing skills for identifying and describing emotions and improving coping skills.

Funding: Not applicable