Abstracts

RATIONALE: Previous research has shown gender differences in psychogenic non-epileptic seizures (NES). Specifically, males have been shown to have convulsive episodes, whereas females have been shown to have non-convulsive episodes. The purpose of this study is to examine gender differences in affect and motor expression during a psychogenic NES. Additional behaviors, crying and pelvic thrusting, were also examined.
METHODS: Subjects included 111 patients (29 males, 82 females) diagnosed with psychogenic NES who were evaluated at the Regional Epilepsy Center in Seattle between 1993 and 2001. All patients had at least one documented psychogenic seizure with no co-existing epileptic seizures or interictal discharges documented by long-term EEG-video monitor studies. The patients had a total of 672 seizures. Two independent researchers reviewed videotapes from these studies to ensure reliability. Each patient was classified as having seizures with: 1) motor components consisting of localized movements, repetitive movements, or tonic clonic motor activity; 2) affectual changes consisting of crying, screaming, panic or fear; 3) staring spells or subjective events in which no motor activity or affectual changes were noted. Patients were also categorized as exhibiting or not exhibiting crying or pelvic thrusting.
RESULTS: The proportion of females exhibiting affectual changes during a psychogenic NES was significantly greater than the proportion of males [chi]2(1, N = 111) = 6.477, p = .011. Also, the proportion of females that cried during a seizure was significantly greater than the proportion of males [chi]2(1, N = 111) = 6.621, p = .01. No significant gender differences were found in the incidence of seizures with a motor component, pelvic thrusting or staring spells.
CONCLUSIONS: Understanding the nature of and gender differences in psychogenic NES can assist physicians in the diagnostic process and in treatment recommendations. This study provides evidence that females are more likely to exhibit an affectual change and/or cry during a psychogenic NES. Males and females were equally likely to exhibit pelvic thrusting, staring spells or a motor component during the seizure.