Abstracts

RATIONALE: Up to 25% of intractable seizure patients are estimated to have PNES; paroxysmal behavior falsely attributed to epilepsy whose morbidity worsens with delayed diagnosis. No population based estimate of gender distribution is available, but 75% female prevalence is widely reported. Referral patterns to monitoring units may be distorted by reliance on gender-related PNES [dsquote]risk factors[dsquote] (RFs); ie sex abuse & somatization. Identification of explicit gender related RF differences might clarify etiology and promote early monitoring of males with PNES .
At the end of this activity, participants should be familiar with PNES risk factor gender differences and predictive value.
METHODS: We prospectively studied 85 admissions to our monitoring unit diagnosed as : 1. Female Epilepsy (n=21) 2.Female PNES (n=29) 3. Male Epilepsy (n=17) 4. Male PNES(n=9). Patients with PNES + epilepsy or who could not be diagnosed were excluded. Twelve main historical and symptomatic PNES RF[ssquote]s were derived from a structured interview and compared x gender for frequency, predictive value, & rank order. These include: [Psi]treatment hx., arrest or medicolegal hx., physical abuse, self-injurious behavior, subjectively worse or no better with AED[ssquote]s, drug abuse hx., sz [gt]5 minutes, headache aura, other somatization hx, [gte]3 sz types, ETOH abuse, sexual abuse.
RESULTS: The presence of [gte]4 RF[ssquote]s correctly classified 89% of PNES females (5% false +) and 93% (12% false +) of males. With [gte]5 RF[ssquote]s there were no false +[ssquote]s; male or female. RANKING of RF[ssquote]s differed significantly x gender with co-occurrence of only 2 ([Psi] hx & legal/litigation hx) of the 8 most frequent. Most frequent PNES RF[ssquote]s: MALE- [Psi] hx (89%), legal, physical abuse hx (both 78%), self-injurious (67%), poor AED response (55%). FEMALE- [Psi]hx (83%), somatization (76%), [gte]5 min. sz duration (72%), sex abuse, legal (both 66%). Individual RF frequency differed x gender: sex abuse (11% male vs 66% female, p[lt].001; somatization (33% male vs 76% female, p[lt].03.
CONCLUSIONS: Risk factor analysis correctly classified a high % of PNES patients, but men[ssquote]s PNES risk factors are somewhat different than women. Psych treatment hx is the most common RF in both genders, but high base-rates in epilepsy only patients makes it less useful by itself. Men with PNES are less likely to have histories of somatization and sex abuse, and tend to be more often self-injurious and to have been subjects of violence. PNES womens[ssquote] higher rates of somatization may be related to their higher rates of sexual abuse. PNES males tend to average a smaller number of RF[ssquote]s and reqire fewer for accurate classification than women. Testing of the standardized PNES risk factor analysis protocol at other sites and development of gender specific norms is warranted.