Trauma, stress, and preconscious threat processing in patients with psychogenic nonepileptic seizures

Abstract

SUMMARYPurpose: Psychogenic nonepileptic seizures (PNES) have long been considered as paroxysmal dissociative symptoms characterized by an alteration of attentional functions caused by severe stress or trauma. Although interpersonal trauma is common in PNES, the proposed relation between trauma and attentional functions remains under explored. We examined the attentional processing of social threat in PNES in relation to interpersonal trauma and acute psychological stress. Methods: A masked emotional Stroop test, comparing color-naming latencies for backwardly masked angry, neutral, and happy faces, was administered to 19 unmedicated patients with PNES and 20 matched healthy controls, at baseline and in a stress condition. Stress was induced by means of the Trier Social Stress Test and physiologic stress parameters, such as heart rate variability (HRV) and cortisol, were measured throughout the experiment. Results: No group differences related to the acute stress induction were found. Compared to controls, however, patients displayed a positive attentional bias for masked angry faces at baseline, which was correlated to self-reported sexual trauma. Moreover, patients showed lower HRV at baseline and during recovery. Discussion: These findings are suggestive of a state of hypervigilance in patients with PNES. The relation with self-reported trauma, moreover, offers the first evidence linking psychological risk factors to altered information processing in PNES.

Basal cortisol is positively correlated to threat vigilance in patients with psychogenic nonepileptic seizures

“…Nineteen patients with PNES and 20 HC from the Bakvis et al study were included in the study [7]. Patients with PNES who were being treated at SEIN, Epilepsy Institute in The Netherlands, were recruited by the attending neurologists.…”

“…Patients with PNES who were being treated at SEIN, Epilepsy Institute in The Netherlands, were recruited by the attending neurologists. The main inclusion criteria were (1) diagnosis of PNES based on an ictal video/EEG recording of a typical seizure and (2) no current use of medication (see Table 1 for demographics, seizure characteristics, and menstrual cycle information, and see [7] for detailed inclusion criteria). In addition, 17 patients with ES without suspicion of (a history of) comorbid PNES based on EEG recording (with or without additional neuroimaging data), medical history, seizure semiology, and antiepileptic drug treatment (AED) experience, who were being treated at SEIN, were recruited by their neurologist.…”

“…However, all these findings rely on self-reports, and to our knowledge, only one study has investigated whether PNES are associated with increased threat sensitivity using an objective threat processing (reaction time) task. Bakvis et al [7] found increased threat vigilance, as indicated by an attentional bias for displays of angry faces in an emotional Stroop task, in individuals with PNES as compared with matched healthy controls (HC). In addition, two studies have reported increased basal cortisol levels in patients with PNES [8,9], one of which indicated that the basal hypercortisolism was independent of current seizures [9].…”

“…Cortisol may enhance processing of angry faces [10,11] and, although these findings are suggestive of a relationship between basal cortisol levels and threat vigilance in patients with PNES, no studies have directly tested this premise. We reanalyzed previous data on threat vigilance in 19 unmedicated patients with PNES and related the previously reported attentional bias (AB) scores for angry faces [7] to newly analyzed baseline (pretask) cortisol levels. In addition, we tested the specificity of eventual effects by investigating the same relationship in the HC reported in Bakvis et al [7] and in a new control group of 17 patients with epileptic seizures (ES).…”

“…We reanalyzed previous data on threat vigilance in 19 unmedicated patients with PNES and related the previously reported attentional bias (AB) scores for angry faces [7] to newly analyzed baseline (pretask) cortisol levels. In addition, we tested the specificity of eventual effects by investigating the same relationship in the HC reported in Bakvis et al [7] and in a new control group of 17 patients with epileptic seizures (ES). We predicted that the cortisol levels would be positively correlated to the enhanced AB scores for angry faces of patients with PNES.…”