Abstracts

RATIONALE: Patients with coexisting epileptic and nonepilepic seizures have neurological and psychological processes affecting their medical condition, and their emotional and psychosocial adjustment. In previous studies, adjustment difficulties have been found in patients who have either epileptic seizures or nonepileptic seizures. In many of these studies, however, these groups differ, with nonepileptic seizure patients having poorer adjustment. On the basis of this research, it would be expected that patients having both epileptic and nonepileptic seizures would have poor emotional and psychosocial adjustment. However, the degree to which these patients resemble those with epileptic seizures or those with nonepileptic seizures is unknown. The objective of this study was to compare the emotional and psychosocial adjustment of patients who have both epileptic and nonepileptic seizures with those who have either epileptic seizures or nonepileptic seizures.
METHODS: Comparisons were made between three groups of 21 adults each: Patients diagnosed with both epileptic and nonepileptic seizures (COEX), patients with nonepileptic seizures only (NES), and patients with epileptic seizures only (SZ). All patients had undergone long-term EEG and video monitoring, with seizure diagnoses made on the basis of these studies. All patients had assessments of intelligence and completed the Minnesota Multiphasic Personality Inventory (MMPI) and the Washington Psychosocial Seizure Inventory (WPSI).
RESULTS: Groups were compared using a one-way ANOVA, with post-hoc follow-up tests to examine differences between means. There were no differences between groups in gender or handedness. A significant difference was found in intelligence between COEX (low average FSIQ) and NES (average FSIQ) . On the MMPI, COEX patients showed elevations on eight scales. However, the only significant difference for this group appeared on Scale 8 (Sc), with COEX patients (Sc = 83) significantly more elevated than SZ patients (Sc = 70). On the WPSI, the COEX group reported significantly more adjustment difficulties than SZ patients in most areas assessed, including emotional status and relationships with family and others. They also reported much greater distress pertaining to seizures than the other two groups. Finally, the COEX and NES groups reported greater dissatisfaction with the medical management of their seizure disorders, compared to SZ patients.
CONCLUSIONS: Although patients with coexisting epileptic and nonepileptic seizures reported emotional turmoil, it was similar to that of patients with epilepsy and those with nonepileptic seizures. However, they had poorer psychosocial adjustment in many areas when compared to these two groups. The direction of causality is not clear. It may be that the two disorders, in combination, have a more adverse impact on an individual[ssquote]s life than either disorder in isolation. Alternatively, higher levels of psychosocial distress in seizure patients may precipitate nonepileptic seizures. Interestingly, nonepileptic seizures were associated with dissatisfaction about medical care, independent of the presence of epileptic seizures. This may be a manifestation of psychological forces at work in somatic disorders. However, it also may reflect a lack of treatment approaches for nonepileptic seizures in the medical arena.