Abstracts

RATIONALE: Patients with Non Epileptic Seizure Like Events (NESLE) are believed to have more psychopatholgy and, in particular, may be more likely to have conversion disorder. The MMPI-2 is one of the most widely used measures of personality and certain patterns of responding are believed to be associated with increased risk of hysteria and conversion disorder. This study compared patients with suspected and documented NESLE with patients who did not have NESLE during video EEG (vEEG) for evidence of conversion disorder on the MMPI-2.
METHODS: 67 patients admitted for vEEG, as part of an evaluation for surgery or for evaluation for NESLE, were administered the MMPI-2. Using chi square analyses, patient groups were compared for the incidence of the classic [dsquote]conversion V[dsquote] pattern and clinical elevations on Scale 3 (Hysteria or Hy).
RESULTS: Of the 42 patients with suspected NESLE, 18 (43%) had no events (NE), 14 (33%) had NESLE, 7 (17%) had epileptiform activity (EA), and 3 (7%) had unclear events (i.e., neither clearly EA or NESLE). All 25 presurgical patients had EA during vEEG. Patients with unclear events were excluded. The only significant difference was in the incidence of Hy elevation based on reason for referral (p =.02), with NESLE eval patients having a higher probablity of elevated Hy compared to presurgical patients (74% vs. 46%). Similarly, there was a trend (p=.08) for patients with NESLE during vEEG to have an elevated Hy relative to patients with EA (52% vs. 79%). Patients referred for NESLE evals who had NESLE during monitoring were not significantly different from patients who had NE in the frequency of conversion V or Hy elevations (50% vs. 36% or 72% vs. 79%). In addition, these patients were not different in the incidence of conversion V or Hy elevations from those who were determined to have NESLE vs. EA during vEEG (36% vs. 57% or 71% vs. 79%).
CONCLUSIONS: NESLE eval patients were more likely to have Hy scale elevations relative to surgical eval patients. There was a trend, in whole group, for patients with NESLE to be more likely to have this elevation relative to patients with EA, but this was not seen when analyzing only the patients initially suspected of having NESLE. In the NESLE eval group, those who had NE were not different from those who had NESLE. Although the incidence of scale Hy elevation was consistently in the expected direction in all analyses, the incidence of conversion V did not approach significance in the patients with suspected or demonstrated NESLE and was not consistently in the expected direction. These data suggest that the Hy scale may be helpful in evaluating for NESLE, but the conversion V pattern may be less so.
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