Abstracts

Psychogenic non-epileptic seizures (PNES) often manifest differently in different patients. Selwa et al. ([italic]Epilepsia [/italic]2000; 41(10): 1330-1334) developed a system of PNES classification to describe different types of spells. Previous research has demonstrated that patients with PNES are commonly associated with elevations on the hypochondriasis and hysteria scales of the MMPI. In the present study, we sought to investigate the relationship between PNES spell type and MMPI profiles. We reviewed video-EEG reports and MMPIs in 86 patients diagnosed with definite PNES after inpatient video-EEG monitoring at the University of Cincinnati between January 2000 and March 2003. Definite PNES was defined as habitual spells recorded on video-EEG without an ictal EEG discharge and normal background alpha rhythm during the event. The diagnosis of PNES was based on the results of the prolonged video-EEG monitoring (PVEM), clinical characteristics of the events recorded, and other supporting evidence (e.g., neuropsychological testing/MMPI). Patients with mixed PNES and epileptic seizures were excluded. Based on review of spells, each patient was classified as predominantly or exclusively belonging to the catatonic, thrashing, automatisms, tremor, intermittent, or subjective categories of nonepileptic seizure type based on Selwa[apos]s classification. MMPI data were collected on each patient as part of the standard neuropsychological battery obtained prior to discussion of the diagnosis with the patient. We found that the largest groups consisted of patients with intermittent (n=22), subjective (n=21), and thrashing (n=19) types of PNES. Analysis of variance results indicated that there was a significant effect of PNES spell type on MMPI standardized T-scores on a combination of the hypochondriasis scale (1) and the hysteria scale (3) (F= 3.87, p = 0.003). Post-hoc pairwise comparisons with a Bonferroni correction for multiple comparisons revealed that patients with catatonic-type PNES had significantly lower scores on scales 1 and 3 than all other PNES types. No other MMPI scales were found to be significantly related to PNES spell type. We found that patients classified with catatonic-type PNES had significantly lower scores on the hypochondriasis and hysteria scales of the MMPI, as compared to all other types of PNES. According to previous research, patients in the catatonic subgroup tended to have a better outcome than other PNES types. This improved outcome in the catatonic group may be related to their decreased pathology on MMPI scales 1 and 3.