Evidence-Based Reviews

Eye-opening behaviors help diagnose nonepileptic seizures

Current Psychiatry. 2006 November;5(11):121-130

References

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Family and patient traits. Studies comparing family functioning in patients with ES and PNES reveal:

individuals with PNES view their families as more dysfunctional, particularly in regard to communication²³
family members of patients with PNES reported difficulties defining roles²³
patients with PNES score higher on measures of somatic complaints when compared with other seizure patients.²⁴

Pain disorders are also common in patients with PNES. Among epilepsy clinic patients, a diagnosis of fibromyalgia or chronic pain has an 85% positive predictive value for PNES.²⁵

Neuropsychological measures. A number of studies describe the cognitive, emotional, personality, and psychomotor differences between ES and PNES cohorts (Table 2).^26-29 Patients with ES and PNES perform about the same on neuropsychological measures but worse than healthy controls. Patients with PNES appear to suffer from cognitive and somatic distress and anxiety. Studies reveal they also have difficulties expressing this distress to family members and others.

Table 2

Neuropsychological (NP) differences between PNES and ES

Feature	Differences
Cognitive ability	Patients with ES and PNES show no significant differences on tests of intelligence, learning, and memory but score lower than healthy control subjects²⁶
Psychomotor skills	Patients with PNES show reduced motor speed and grip strength, compared with healthy controls²⁷
Motivation	Patients with PNES score lower on motivational measures than ES patients, perhaps reflecting a lack of psychological resources necessary to persist with a challenging NP battery; frank malingering is thought to occur rarely in PNES²⁸
Personality	Minnesota Multiphasic Personality Inventory (MMPI-2) studies show elevations in hypochondria, hysteria, and depression scores in patients with PNES²⁹