Abstracts

Investigators commonly identify epileptic seizures (EPI) and psychological non-epileptic events (NES) during EEG monitoring, but in most cases no reference is made to reports of [quot]seizures[quot] by patients which are purely subjective (SUB) and which have neither EEG nor clinical changes. This is true even though there is the recent suggestion in the literature that SUB (Epilepsia 1998;39:857-862) is both important and largely independent of EPI and NES. All 857 adults (age 16-76) with EEG monitoring (average of 5.83 days) during an 8.5 year period were included. All were reported to have episodes which possibly or probably represent epilepsy. Monitoring established the nature of the episodes reported, and suitability for various forms of treatment including surgery. All patients had also completed the WAIS-R, much or all of an expanded Halstead-Reitan neuropsychological battery, the MMPI, and the WPSI (Washington Psychosocial Seizure Inventory). The types of events and their frequencies among the 857 patients were as follows: EPI only 298; NES only 120; SUB only 128; EPIL+SUB 135; SUB+NES 51; EPIL+NES 13; EPIL+NES+SUB 7; no events of any type, 106. ANOVAs run across the groups with one type of event and with two types events on the variables of interest constituted the primary analyses. [underline]Biodata[/underline] variables evaluated included age (no differences across the groups), gender (SUB and NES were similar with about 70% female; EPI 50%; p [lt] .001), and years of education (SUB slightly but not significantly better educated than NES and EPI). [underline]Medical history/monitoring[/underline] variables included age at onset of seizures (EPI much earlier than NES and SUB which were similar; p [lt] .001), psychiatric history (NES and SUB similar and much higher than EPI; p [lt] .001), neurological history other than seizures (n.s.), total episodes recorded during monitoring (n.s.), and days of monitoring required (SUB [gt] NES, EPI intermediate; p [lt].001). [underline]Mental ability[/underline] variables showed EPI patients to be below NES and SUB in many cases, with SUB often being slightly but non-significantly better than NES. WAIS-R VIQ, PIQ, FSIQ, and overall percent of neuropsychological tests outside normal limits were all significantly different across the groups (p [lt] .01--p [lt] .001). [underline]Emotional adjustment[/underline] variables from the MMPI showed SUB to be more depressed than NES and EPI (p [lt] .001) but with similar scores which were higher than EPI on scales emphasizing somatic focus and unusual thought patterns (p [lt] .01--p [lt] .001). [underline]Psychosocial[/underline] variables from the WPSI showed scores which were worse for SUB than for either NES or EPI (Family Background, p [lt] .001; Emotional Adjustment, p [lt] .001; Overall Psychosocial Adjustment, p [lt] .01). Reports of [quot]seizures[quot] during EEG monitoring without either the electrographic changes of EPI or the behavioral changes of NES need to be routinely recorded as they have substantially different characteristics. The investigation of such spells may lead to new insights in several areas.