Seizure semiology in males with psychogenic nonepileptic seizures is associated with somatic complaints.

AIMS: Psychopathology has been studied in patients with epileptic or psychogenic non-epileptic seizures in the context of diagnosis and treatment. Unfortunately, most PNES studies include few males and do not consider possible gender differences, making findings less generalizable to males with PNES. In this study we specifically compare males with PNES to females with PNES and to males with epilepsy. METHODS: Males with PNES (n=58), males with epilepsy (n=86), females with PNES (n=147), and females with ES (n=142) were evaluated on an inpatient epilepsy monitoring unit. Self-reported objective measures of psychopathology, demographics, and PNES seizure semiology were compared. RESULTS: Personality Assessment Inventory profiles revealed marked differences, particularly in somatic symptoms, between PNES and epilepsy. Females with PNES had higher levels of physiological depressive symptoms but lower antisocial features. Males with PNES who had clinically significant elevations on the somatic complaints scale were much more likely to have motor seizures while females with PNES classified similarly were equally likely to have either motor or non-motor events. CONCLUSION: Gender difference in PNES seizure semiology was associated with whether or not clinically significant somatic symptoms were present; males with elevated somatic symptoms were much more likely to have motor PNES. However, we did not find evidence of greater psychopathology in males with PNES compared to females with PNES. Gender differences in the behavioral manifestation of PNES in the context of presence or absence of somatization may have implications for diagnosis and treatment.

Concurrent administration of the MMPI-2 and PAI in a sample of patients with epileptic or non-epileptic seizures: implications for an inpatient epilepsy monitoring unit.

The Minnesota Multiphasic Personality Inventory-second edition (MMPI-2) and the Personality Assessment Inventory (PAI) are commonly used in the epilepsy monitoring unit (EMU) to evaluate personality characteristics and mood-related symptoms in those individuals being evaluated for epileptic seizures (ES) or psychogenic non-epileptic seizures (PNES). A direct comparison of these measures through concurrent administration to the same group has not been carried out. Both measures were administered to 40 patients (17 ES and 23 PNES). Logistic regression suggested the optimal predictive model for EMU discharge diagnosis included subscales from each measure, which outperformed either measure separately. Combining the conversion (SOM-C) and health concerns (SOM-H) subscales from the PAI and the hysteria subscale (Hy) from the MMPI-2 resulted in 85% overall classification accuracy, 86.7% sensitivity, and 82.4% specificity. Variability in the literature regarding the predictive utility of these measures may stem from the possibility that they measure different aspects of PNES.

The NAB shape learning subtest as a predictor of lateralized seizure onset.

This study presents the first empirical evaluation of the predictive value of the Neuropsychological Assessment Battery Shape Learning (NAB-SL) subtest in a sample of patients with unilateral temporal lobe epilepsy. Stimulus characteristics of the NAB-SL may improve predictive ability over other commonly used visual memory tests. Forty-nine patients with unilateral temporal lobe epilepsy were compared on measures of non-verbal and verbal memory (NAB-SL and Wechsler Memory Scale-III subtests). Univariate and forward conditional logistic regressions identified predictive values for each memory test individually and in combination. The NAB-SL delayed memory demonstrated consistently stronger predictive power over visual reproduction at the univariate and multivariate levels. The NAB-SL was a good predictor (80% range) of lateralized seizure onset when combined with a verbal memory measure. These preliminary results provide support for the use of the NAB-SL in preoperative epilepsy evaluations as a predictor of non-dominant temporal lobe dysfunction. Potential benefits of this test are discussed.

Neuropsychological outcome following minimal access subtemporal selective amygdalohippocampectomy.

PURPOSE: The present study provides a detailed account of neurocognitive outcome following minimal access subtemporal selective amygdalohippocampectomy (SAH) and establishes rates of neurocognitive decline in the largest sample to date. Use of a subtemporal surgical approach to SAH has been proposed to possibly reduce the risk for postoperative neurocognitive decline since lateral neocortical tissues is not resected and the temporal stem is preserved. The current study extends prior research with subtemporal SAH patients to include not only group level analyses but also analyses based on reliable change data. METHODS: Neurocognitive comparisons are made between 47 patients that underwent subtemporal SAH. Statistical comparisons were made between neurocognitive performance at the group level and with use of reliable change scores. RESULTS: Approximately 75% of patients were seizure free postoperatively. At the group level, there were no significant postoperative changes. For the left SAH patients, reliable change scores demonstrated a decline in approximately one third of patients for memory, verbal intellect, and naming. Right SAH patients showed decline primarily in memory. CONCLUSIONS: These results indicated good seizure control following subtemporal SAH with greatest risk for neurocognitive decline following dominant SAH and best cognitive outcome following non-dominant SAH. Findings demonstrated the importance of reliable change analyses that make individual based comparisons and take into account measurement error. Despite preservation of the lateral neocortical tissue and the temporal stem, subtemporal SAH presents a risk for cognitive decline in a notable portion of patients.

Predicting psychogenic nonepileptic seizures with the Personality Assessment Inventory and seizure variables.

Early identification of likely cases of psychogenic nonepileptic seizures may prompt earlier and more appropriate diagnosis and treatment. This study investigated the validity of multiple independent self-report variables in predicting psychogenic nonepileptic versus epileptic seizures. One hundred forty-three patients with psychogenic nonepileptic seizures and 129 patients with epileptic seizures were compared with the Personality Assessment Inventory, age at seizure onset, years since first seizure, and length of seizures. Diagnostic prediction was made by analyses of variance and logistic regressions. Cut scores were developed for the multivariate predictors with maximal sensitivity and specificity. The Personality Assessment Inventory conversion subscale (SOM-C), years since first seizure, and length of seizures provided 84% correct classification. Ninety-six percent of patients meeting cut scores of SOM-C ≥70, years since first seizure ≤8, and length of seizures ≥3 minutes were diagnosed with psychogenic nonepileptic seizures. Results demonstrated good ability to identify likely cases of psychogenic nonepileptic seizurs by multiple predictors that are easily and cost-effectively obtainable.

Neuropsychological characteristics of nonepileptic seizure semiological subgroups.

The present study sought to identify neuropsychological characteristics of patients with nonepileptic seizures (NESs) based on seizure semiological subgroups and to make comparisons among NES subgroups and with patients with temporal lobe epilepsy (TLE). A total of 173 patients with NESs and 180 patients with TLE were included in this study. Statistical comparisons were made between a NES four-subgroup model, a NES two-subgroup model, and patients with TLE on neurocognitive measures. A trend toward declining performance was noted across the subjective, catatonic, minor motor, and major motor subgroups, respectively. The nonmotor subgroup showed stronger performance on verbal intelligence, naming, verbal learning, and verbal memory compared with the TLE group. The motor subgroup generally performed equivalently to the patients with TLE. Results indicate that patients with more dramatic seizure semiology appear to have lower neurocognitive functioning at a level comparable to that of patients with TLE. Patients with NESs with the least dramatic semiology appear to have fewer neurocognitive abnormalities.

Motivation, psychopathology, locus of control, and quality of life in women with epileptic and nonepileptic seizures.

To examine factors that may potentially aid in the differential diagnosis and subsequent tailoring of treatment for patients with epileptic (ES) and psychogenic nonepileptic (PNES) seizures, thirty female patients with PNES and 51 female patients with temporal lobe epilepsy were assessed in the areas of motivation, psychopathology, health-related locus of control (HRLOC), and health-related quality of life (HRQOL). The two groups demonstrated equivalent levels of motivation, clinically elevated yet comparable mood symptoms, and no general differences in HRLOC. Despite similar mood disturbances in both groups, the participants with PNES had a later age of seizure onset, exhibited greater personality disturbances, attributed more control over their condition to nonphysicians, and endorsed a greater negative impact of their seizures on physical and emotional aspects of HRQOL. Preliminary analyses suggest that chronic anxiety and overall HRQOL may be core discriminators between these seizure groups. Addressing such issues may prove useful in tailoring more specific treatments for these etiologically disparate conditions.

Anosognosia for hemiplegia with preserved awareness of complete cortical blindness following intracranial hemorrhage.

A 51-year-old woman presented with anosognosia for hemiplegia (AHP), neglect, and a complete loss of vision, for which she was almost immediately aware. Neuroimaging studies revealed intracranial hemorrhages in the medial temporal lobes bilaterally, extending back to the occipital cortex, but sparing the calcarine cortex. A large right frontal-parietal hemorrhage which extended to the posterior body of the corpus callosum was also observed. The patient's vision slowly improved, and by 11 months post onset, formal visual fields revealed improvement primarily in the left upper quadrants only. In contrast, resolution of her AHP occurred between the 26th and 31st day post onset. Awareness of motor impairment was correlated with her ability to initiate finger tapping in her left hemiplegic/paretic hand. During the time she was unaware of her motor deficits but aware of her visual impairments, her dreams did not reflect concerns over visual or motor limitations. The findings support a "modular" theory of anosognosia.

A comprehensive neuropsychological profile of women with psychogenic nonepileptic seizures.

The purpose of this study was to compare the neuropsychological profile of women with VEEG-confirmed diagnoses of psychogenic nonepileptic seizures (PNES) with that of an age- and education-matched group of women with left temporal lobe epilepsy (LTLE). Results indicate that in a relatively homogenous PNES sample, no severe neurocognitive impairments were present, further supporting a psychologically versus neurologically driven pathology of PNES. In comparison to age-stratified normative data, the PNES group demonstrated only a modest deficiency across neuropsychological domains and a relative area of weakness in attention and working memory, and generally outperformed their counterparts with LTLE. Although the attentional deficits in the PNES group may have been influenced by their elevated levels of emotional distress, symptoms of depression and anxiety were significant and common in both patients with PNES and those with LTLE, and therefore, the utility of psychological factors in discriminating these groups is limited. The present findings warrant the use of longitudinal research with patients with PNES to identify changes in the presentation of this condition as well as its subsequent neurocognitive and emotional impairments.