Abstracts

Rationale: Semiological features during psychogenic non-epileptic seizures (PNES) have not been well studied in relation to the disorder’s underlying psychopathology. Altered responsiveness is a distinct feature that may signal a particular psychological vulnerability, such as emotional avoidance or dissociation.Methods: 71 patients with video-EEG confirmed PNES were divided into two groups based on their responsiveness at the time of the captured event during long-term monitoring. Information regarding each patient’s demographic and clinical history was obtained with a semi-structured neuropsychiatric interview. Patients also completed self-reported questionnaires to assess psychopathological variables. This study was approved by the institutional review board.Results: 47 patients (66%) had altered responsiveness during their captured event and 24 (34%) did not. Demographic variables did not differ between the two groups, with the exception of marital status (p<0.01). A larger proportion of separated/divorced or widow patients were normally responsive during their events (66.7%), compared to other marital statuses (18.4% of married/partnered patients and 42.9% of never married patients had intact responsiveness). The Acceptance and Action Questionnaire II demonstrated a higher level of experiential avoidance in patients with altered responsiveness (mean=28.98, SD=12.15) compared to those with intact responsiveness (mean=21.56, SD=10.61) (p=0.03). The Tolerating subscale of the Affective Style Questionnaire showed a less accepting and tolerant attitude towards emotions in patients with altered (mean=13.83, SD=3.7) versus intact responsiveness (mean=16.71, SD 3.5) (p=0.01). Other clinical variables that significantly differed between the two groups include a family history of seizures (83% in altered versus 53% in intact responsiveness patients), comorbid headaches (74% in altered versus 44% in intact responsiveness patients) and, for those with a history of traumatic brain injury (TBI) (59% of our sample), the reported presence of loss of consciousness (LOC) during the TBI was more common in the altered responsiveness group (83%) compared to the intact responsiveness group (53%). There were no differences in measures of dissociation, somatization, mood or anxiety.Conclusions: While semiology cannot replace a psychiatric examination for PNES patients, altered responsiveness during the event may provide an indirect measure of patients’ response to emotional states. Differences in emotion processing (more avoidance, less acceptance and lower tolerance towards emotional states) are seen in those PNES patients with altered responsiveness. Emotion management is a suitable therapeutic target and hence semiology may inform certain aspects of treatment. Prior experiences with LOC (through prior exposure to seizures in family members or LOC during TBI) also contribute to the presence of altered responsiveness. More investigations are needed to understand the mechanism of these previous experiences leading to this specific semiological feature.