Abstracts

Rationale: In the absence of scientific explanation, humankind historically used supernatural frameworks to explain epilepsy. “Seizure” by supernatural forces underlies the historic association of religion with epilepsy. The ancient Greeks termed epilepsy “the sacred disease,” as it was thought to be a visitation by the gods. Psychogenic non-epileptic seizures (PNES) are phenotypically-similar to epilepsy but are not actually epileptic in origin. The role of belief systems in PNES should not be overlooked. This pilot study highlights the results of a survey designed to test the hypothesis that PNES subjects were more likely than epileptic subjects to possess supernatural beliefs, predisposing them to the development of non-epileptic spells. Methods: Through chart review of the electronic medical record of the Epilepsy Clinics at Spectrum Health in Grand Rapids, Michigan, a sample of adult patients with a confirmed diagnosis of either epilepsy or PNES were identified and offered to complete an optional, anonymous survey. Subjects bearing a dual diagnosis of both epilepsy and PNES were excluded. Focuses of the survey included personal beliefs systems (religious, spiritual, supernatural, and paranormal beliefs), and demographic measures. Thirty-eight subjects with PNES and 28 subjects with epilepsy were enrolled. The nominal data generated from this study was compared using the two-tailed Chi-squared test. Significance was assessed at p<0.05. Results: Ethnicity, race, educational background, or substance usage history between PNES and epileptic patients were not significantly different. Statistically-significant differences were noted in terms of Christian versus non-Christian affiliation (p=0.049; almost 80% of the epileptic group selected Christian vs just over half for the PNES group), and self-reported English-Spanish bilingualism (p=0.015; a higher percentage of PNES patients reported bilingualism). The belief systems between the two groups were not significantly different for most of the questions asked. A logistic regression using the outcome variable of 'yes' or 'no' revealed PNES respondents were 5.6 times more likely to report a belief in supernatural forces when queried from a list of potential options, even when controlled for religious affiliation and sex. Our survey tool listed several common supernatural phenomena, such as angels, demons, evil spirits, ghosts, voodoo, and black magic; PNES respondents showed a tendency to report a belief in an “other” or non-specified supernatural entity than was listed on the survey (p=0.048). There was no statistically significant difference in the rates of respondents who felt that their seizures were a divine gift or punishment. A statistically significant difference between the respondents’ beliefs in climate change, evolution, and intelligent design was not evident. Conclusions: Compared to patients with epilepsy, PNES subjects had a tendency to report supernatural beliefs when queried from a list of options. This may represent increased belief in supernatural forces in PNES. Alternatively, it may be an example of the increased suggestibility in persons with PNES, as implied in prior studies showing PNES patients bore a tendency to report multiple medication allergies and a higher percentage of positive complaints on a Review of Systems questionnaire. Funding: No funding