Abstracts

RATIONALE: While psychiatric and medical studies of individuals with non-epileptic seizures (NES), or [dsquote]pseudoseizures[dsquote] exist in the literature, exploration of their vocational rehabilitation(VR)concerns is poorly represented, and may represent a worthwhile effort, both in terms of helping this population to realize its economic potential and in reduction of dependence on public subsidy. The present study reviews this population from a VR perspective. Comparisons are made with epilepsy, traumatic brain injury (TBI) and multiple sclerosis (MS) VR populations with respect to demography, level of neuropsychological impairment, emotional status, and VR strategies.
METHODS: In this retrospective study, 83 subjects with NES were identified who had undergone extensive neuropsychological testing between 1982 and 2000. Descriptive statistics were generated. Detailed medical, demographic, and vocational data were available on each subject. Employment status was determined for subjects in the workforce (n=68). These data were used to compare the sample with neurological populations served by our Vocational Rehabilitation Unit(epilepsy, TBI, MS) during the same time period. Because of questions concerning differential etiology, data were reviewed by gender.
RESULTS: Partial data summary:
Males (n=25):
Unemployment Rate: 76%; FSIQ 94.28 (15.56); Dodrill Impairment Index:51.16 (25.94);MMPI Welsh Code:812[dsquote]374[ssquote]F9650/LK-;`
Marital status: 32 percent married; One or more motor vehicle accident (MVA) with significant injury:32%; History of significant drug/alcohol(D&A) abuse: 28%
Females (n=58):
Unemployment Rate 77%; FSIQ 89.41 (13.91);
Dodrill Impairment Index: 48.91 (27.43);
MMPI Welsh Code: 8132[ssquote]794F60/KL-5:;
Marital status: 26 percent married; One or more MVA[ssquote]s with significant injury:29%; History of significant D&A abuse: 17%; History of physical/sexual abuse: 28%.
CONCLUSIONS: The unusually high level of unemployment in this sample exceeds estimates of epilepsy and TBI unemployment in the national workforce, and more closely approximates that of persons with MS. Moreover, from a neuropsychological perspective, this sample closely resembles that of persons with epilepsy seen for specialized VR services at our Center. Although persons with NES may be appropriately seen as psychiatrically compromised, the neuropsychological results from this sample, as well as high levels of reported physical trauma, from MVA[ssquote]s and other sources, suggests the utility of adapting elements of VR models designed to work with neurological populations in providing VR services. Reported history of sexual/physical abuse in the female sample, while disturbingly high, likely underestimates the magnitude of the problem, as per relevant literature review, clinical experience at our Center, and further complicates VR issues. There may be large potential economic and social benefits in providing effective VR services for the NES population.