ABSTRACT
BACKGROUND: HRQOL is lower in patients with psychogenic non-epileptic seizures (PNES) than in epilepsy patients. Although psychopathology may reduce HRQOL, it is not known whether patients with PNES and epilepsy are similarly affected. We aimed to compare the relationship between psychopathology and HRQOL in PNES and treatment resistant epilepsy. MATERIAL/METHODS: 106 patients with definite diagnosis of PNES or epilepsy were recruited from Epilepsy Monitoring Unit. Patients completed QOLIE-89, Profile of Mood States (POMS), and Adverse Events Profile (AEP). Total Mood Disturbance (TMD) was derived from POMS. We used chi-square and t tests and hierarchical multiple regression to compare HRQOL and its mental status correlates in patients with PNES and epilepsy. RESULTS: Psychiatric history was more prevalent and depression/dejection and TMD were higher in PNES than epilepsy (P<=0.003). PNES patients had a lower adjusted mean HRQOL than epilepsy patients (P<0.01). Mood problems and AEP were strong predictors of HRQOL (P<0.001) and explained the lower HRQOL in PNES vis-l-vis epilepsy. Decreases in HRQOL due to mood problems were similar in both groups. The model explained 62% of the variation in HRQOL. CONCLUSIONS: Although more severe psychopathology in PNES explains the lower HRQOL in PNES relative to epilepsy, the negative association between psychopathology and HRQOL remains stable across the groups. PNES patients with severe mood problems show similar, low levels of HRQOL as patients with severe mood problems who have epilepsy. Future studies should examine causal linkages between psychopathology and PNES and other explanations in seizure-related QOL.
Subject(s)
Depression , Epilepsy/diagnosis , Psychopathology , Quality of Life , Seizures/diagnosis , Adult , Depression/diagnosis , Depression/psychology , Diagnosis, Differential , Drug Resistance , Epilepsy/psychology , Female , Humans , Male , Middle Aged , Mood Disorders/diagnosis , Mood Disorders/psychology , Seizures/psychologyABSTRACT
PURPOSE: Psychogenic nonepileptic seizures (PNESs) are events that alter or seem to alter the neurologic function and, in their appearance, resemble epileptic seizures (ESs). In patients with ESs the psychological and medical aspects of epilepsy greatly influence the health-related quality of life (HRQOL). The relation between these factors and PNESs is not well established. In this study, we compared HRQOL in patients with PNESs with that of patients with ESs. METHODS: We evaluated 105 patients admitted to the Epilepsy Monitoring Unit of University Hospital between January 20, 2001, and January 20, 2002. Only patients with the definite diagnosis of ESs or PNESs were analyzed (n = 85). Patients completed an epilepsy-specific quality-of-life instrument (QOLIE-89), the Profile of Mood States (POMS), and Adverse Events Profile (AEP). We used t tests and regression analyses to contrast HRQOL in PNESs and ESs and to elucidate the main factors associated with HRQOL in patients with PNESs. RESULTS: In our sample, 45 patients had PNESs, and 40 had ESs. The overall HRQOL and scores on 13 of 19 QOLIE-89 subscales were significantly lower (i.e., worse) in PNES than in ES patients. AEP and scores on five of six POMS subscales also were worse in PNES patients than in ES patients. PNES versus ES diagnosis, POMS depression/dejection, and AEP were significant predictors of HRQOL, jointly explaining 65% variation in HRQOL. The lower HRQOL in PNESs versus ESs was in part explained by depression and AEP. CONCLUSIONS: Patients with PNESs have a lower HRQOL and worse mood problems than do patients with ESs. This disadvantage is primarily due to depression and medication side effects, although these factors influence QOL in much the same way in PNES and ES patients. These baseline HRQOL data on patients with PNESs can be used to evaluate the effects of treatment in this patient population.
