Abstracts

Rationale: The purpose of this study is to compare patients with psychogenic non-epileptic seizures (PNES) alone to those with epilepsy and concomitant PNES on trauma symptoms and quality of life. The latter tend to be overlooked, often excluded from PNES studies, but some reports indicate that they are heterogeneous in terms of psychiatric comorbidities and other clinical variables (e.g., age of diagnosis, use of anti-epileptic drugs) and merit closer examination.

Methods: Patients with epilepsy and concomitant PNES (n=42) were compared to patients with PNES-alone in a retrospective study (n=282). All patients were diagnosed through video-EEG monitoring and underwent comprehensive neuropsychological testing which included the Trauma Symptom Inventory (TSI-2) and the Quality of Life in Epilepsy-31 (QOLIE-31) inventory. The following subscales were analyzed: TSI-2 (Anxious Arousal, Dissociation, Somatization, Depression, and Suicidal Preoccupations) and QOLIE-31 (cognitive, seizure worry, emotional wellbeing, medication effects, social function, and total). Means of the two groups were compared using t-tests.

Results: Compared to patients with concomitant epilepsy and PNES, those with PNES-alone reported a significantly higher score on the Suicidality Index of the TSI-2 (M1 = 55.81, SD =15.56) than the dual diagnosis group (M2 = 48.42, SD =9.46) t(2.02907), p < .02. Patients with PNES-alone also had achieved significantly higher education. No other significant differences were noted, though a trend (p=0.06) for greater medication effects was observed in dually diagnosed patients.

Both groups of patients reported similarly diminished mean scores on Emotional Wellbeing ( < 2 standard deviations) and on the Total Quality of Life (QOL) scale ( < 1.5 standard deviation). Furthermore, the mean score on the Somatic Preoccupation Scale fell in the “problematic” range for the PNES-alone group (M1 = 60.32), while the mean score on the Dissociation scale fell in the “problematic” range for the concomitant PNES and epilepsy group (M=61).

Conclusions: A comparison between patients with PNES-alone and patients with PNES and epilepsy revealed that the former scored significantly higher on a scale that includes items regarding fantasies about dying and intentional suicidal actions. In addition, patients with PNES and epilepsy exhibited a trend in Medication Effects which may be related to differences in anti-epileptic drug (AED) use; subsequent studies should assess AEDs in these groups, as well as other clinical variables. Both samples reported equally poor quality of life, especially regarding emotional wellbeing and total QOL. Future studies should investigate patients who are dually diagnosed with PNES and epilepsy using additional psychometric measures. This is a challenging patient group to treat psychotherapeutically, however, these preliminary results support the importance of this empirical direction.

Funding: Please list any funding that was received in support of this abstract.: None.