Abstracts

Rationale: Alexithymia refers to difficulties in emotional self-regulation. The main characteristics of alexithymia include difficulty experiencing, verbalizing, thinking about, and/or identifying one’s emotions. Prior studies have shown that 30% to 90% of patients with psychogenic non-epileptic seizures (PNES) demonstrate alexithymia. Alexithymia has also been associated with cognitive deficits, specifically those involving verbal abilities and executive functions. The objective of the current study was to examine cognitive differences among PNES patients with alexithymia and PNES patients without alexithymia.Methods: This study included 144 consecutive patients with a diagnosis of PNES confirmed with inpatient video-EEG monitoring who went on to complete a comprehensive neuropsychological battery. The battery included measures which assessed intelligence (WASI), language functions (BNT), executive functions (D-KEFS), and memory (CVLT-II, WMS-III Logical Memory, CVMT). The Toronto Alexithymia Scale (TAS) was utilized to determine the presence or absence of alexithymia. Patients with scores of 60 or above were assigned to the alexithymia group, while patients with scores of 59 or below were assigned to the non-alexithymia group.Results: The alexithymia group was comprised of 11 males and 35 females with mean education of 13 years, while the non-alexithymia group was comprised of 15 males and 84 females with mean education of 14 years. The two groups differed significantly with regard to years education and IQ, but not duration of PNES. As such, analysis of covariance (ANCOVA) was performed on the remaining cognitive variables with education and IQ as covariates. Analyses demonstrated that Logical Memory II, D-KEFS Trails 4, and D-KEFS Category Fluency were found to significantly differ between the two groups, with the alexithymia group earning significantly lower scores on the three measures.Conclusions: Results from the study showed that PNES patients with alexithymia had significantly different (lower) performance on two measures of executive function (semantic fluency and set-shifting/divided attention) and one measure of verbal narrative memory. It is perhaps noteworthy that a significant difference was not detected between groups on another verbal memory measure (CVLT). The Logical Memory and CVLT measures differ in that the former requires the learning and coherent retelling of meaningful content while the latter requires recall of items in list form. As patients with alexithymia find it challenging to verbalize emotions, we might speculate that the narrative aspect of the Logical Memory subtest identifies a particular weakness in these patients that a list-learning task does not. In summary, identifying a distinctive diagnostic category such as alexithymia within the general PNES population is important from a diagnostic and treatment perspective. The present findings suggest that cognitive patterns of PNES patients with alexithymia differ from those without. This should be considered as a factor when working with this particular population.