Behavioural mechanisms involved in pseudoepileptic seizures: a comparison between patients with epileptic seizures and patients with pseudoepileptic seizures

Abstract

The diagnosis of pseudo-epileptic seizures (PES) is confirmed in 7-10% of the patients that are considered to suffer from 'refractory epilepsies'. As yet no consistent model is available to explain the development of PES in individual patients. This open non-randomized clinical study aimed at assessing behavioural mechanisms that trigger PES, independent of the underlying personality characteristics. Twenty-four patients with PES were compared with pairwise matched patients that suffered exclusively from genuine epileptic seizures (ES). The patients were assessed with two personality inventories that measured potential important behavioural mechanisms: the 19 PF-form B of the Cattell IPAT Anxiety Scale and the Dutch ABV-scale, largely based on Eysenck's Maudsley Personality Inventory. This assessment was complemented with individual history taking and psychiatric examination. The results are presented in a model in which three factors are involved that have a combined effect on the development of PES in individual patients: personality disorders (of heterogeneous origin), the behavioural mechanism of somatization and a familiarity with epilepsy as a modifying factor.

Patients with psychogenic nonepileptic seizures, alone or epilepsy-associated, share a psychological profile distinct from that of epilepsy patients

“…Our data seem to confirm at least two aspects of Aldenkamp and Mulder's [1] three factor-mechanism in the genesis of PNESs, i. e., the presence of a psychopathological disorder, and the influence of a "general trigger mechanism", which leads to an increased tendency towards somatisation.…”

“…A low level of schooling was associated with ictal PNES manifestations possibly corresponding to a simplified concept of epileptic seizures [1,4].…”

“…While some authors did not find differences between the personality traits of PNES patients and those of ES patients [1,6,35], others found significant differences [3,7,16,33,37]. The Minnesota Multiphasic Personality Inventory (MMPI) has traditionally been used in the evaluation of PNES patients [3,7,16,33,37].…”

“…Inventories that analyse personality traits rather than psychopathological manifestations could be more discriminating [1].…”

Factors involved in the long-term prognosis of psychogenic nonepileptic seizures

“…For example, 7-10% of patients referred to a specialized epilepsy center in The Netherlands have PNES [1] and, internationally, estimates of up to 33% have been mentioned [2]. In theory, the distinction between epileptic seizures and PNES is evident [3].…”