Personality testing and epilepsy: comparison of two MMPI-2 correction procedures

A longitudinal study of psychological features in patients before and two years after epilepsy surgery

This study aimed at investigating psychological features before and two years after epilepsy surgery. Fifty patients, 39 with temporal lobe epilepsy (TLE) and 11 with frontal lobe epilepsy (FLE), were assessed at baseline and two years postoperatively with the Karolinska Scales of Personality (KSP). Baseline group level outcome was normal while individual level analyses delineated some mild to moderate degrees of psychological problems exceeding the normal range in subsets of patients. Features of hostility characterized half of the FLE and one-fourth of the TLE patients. Above 1/3 in each group had dependency features. About 1/3 of the TLE patients suffered from psychasthenia. In conclusion, even though group levels were normal, several patients had psychological problems. The main longitudinal result was that the personality features were stable and did not change after epilepsy surgery.

The effects of perceived emotional distress on language performance in intractable epilepsy

We evaluated the potential moderating effect of emotional distress (Minnesota Multiphasic Personality Inventory 2, scales D and Pt) on language functioning (i.e., Boston Naming Test, phonemic paraphasic error production on the Boston Naming Test, Controlled Oral Word Association Task, Animal Naming, Token Test) in patients with left (N=43) and right (N=34) mesial temporal lobe epilepsy (MTLE) and frontal lobe epilepsy (FLE) (N=30). Video/EEG and brain imaging results confirmed localization. Logistic regression models revealed that perceived emotional distress moderated language performance. Performance of patients with left MTLE and that of patients with FLE were equally poor across language measures. Performance of patients with right MTLE was intact. Depression and anxiety differentially moderated performance. Anxiety was associated with better performance in patients with FLE on classically temporal lobe-mediated tasks (Boston Naming Test). Depression was associated with worse language performance on measures for which impaired performance was traditionally intrinsic to the underlying epileptogenic lesion (word fluency in FLE). Emotional distress influences language performance. Adequate treatment of mood should be considered when managing pharmacoresistant epilepsy.

The impact of seizure-related items and comorbid medical conditions on the MMPI-2 profiles of patients with epilepsy and psychogenic nonepileptic seizures

This study examined the impact of seizure-related items and selected comorbid medical conditions on Minnesota Multiphasic Personality Inventory, Second Edition (MMPI-2), Scales 1 and 3 and the psychogenic nonepileptic seizure (PNES) profile [Wilkus RJ, Dodrill CB, Thompson PM. Intensive EEG monitoring and psychological studies of patients with pseudoepileptic seizures. Epilepsia 1984;25:100-7] in patients with epileptic seizures (ES) and PNES. Sixty patients with a long-term video/EEG monitoring diagnosis of either ES (N=30) or PNES (N=30) and valid MMPI-2 profiles were included in this study. MMPI-2 seizure-related items [Derry PA, Harnadeck MCS, McLachlan RS, Sontrop J. Influence of seizure content on interpreting psychopathology on the MMPI-2 in patients with epilepsy. J Clin Exp Neuropsychol 1997;19:396-404] were removed to determine if their inclusion overpathologizes and/or misclassifies patients with epilepsy. Removal of seizure-related items did not result in any clinically meaningful changes in MMPI-2 profiles for patients with ES. The presence of comorbid medical conditions was not associated with greater Scale 1 or 3 scores or the likelihood of a PNES profile in either group. Results suggest that clinical elevations on MMPI-2 profiles may not be explained by the presence of seizures or comorbid medical conditions.

Relationship between semiology of psychogenic nonepileptic seizures and Minnesota Multiphasic Personality Inventory profile

Subtypes of psychogenic nonepileptic seizures (PNES) have emerged via classification of seizure semiology, psychological variables, or both. PNES subtypes that differ with respect to etiology may be amenable to targeted treatment strategies. The aim of the present study was to investigate the relationship between semiology type and Minnesota Multiphasic Personality Inventory-2 (MMPI-2) profile among patients with PNES. We did so by modifying a classification scheme proposed by Selwa et al. Our main hypothesis was that there would be significant associations of semiology-based subtypes with psychological profiles among patients with PNES. We found significant differences in mean scores on MMPI-2 clinical scales 1 (Hypochondriasis) and 3 (Hysteria) and Harris-Lingoes subscales D5 (Brooding) and Sc5 (Lack of Ego Mastery, Defective Inhibition) across PNES subtypes (catatonic, minor motor, major motor). The results of the present study enhance understanding of the nosology of PNES by identifying psychopathological correlates of semiology-based subtypes of PNES. Our study also may inform the methodology of future investigations of psychopathology among patients with PNES by providing support for content-based interpretation of the MMPI.

Slight improvement in mood and irritability after antiepileptic drug withdrawal: a controlled study in patients on monotherapy

OBJECTIVE

Most antiepileptic drugs (AEDs) are considered to have effects on mood and to be effective in a number of affective disorders. There are, however, conflicting reports in the literature with respect to the psychotropic properties of AEDs. Many of the studies have a number of methodological problems, and much uncertainty still exists regarding the behavioral and mood effects of AEDs. The aim of this study was to assess, in a randomized, double-blind, placebo-controlled study of seizure-free patients with epilepsy, the effect of withdrawal of AEDs in patients on monotherapy on measures of mood and behavior.

METHODS

One hundred fifteen subjects who had been seizure-free >2 years on drug monotherapy went through a randomized, double-blind, placebo-controlled study. Each patient was included for 12 months or until seizure relapse. Behavioral function was assessed with the Minnesota Multiphasic Personality Inventory 2 (MMPI-2) at baseline and 7 months after withdrawal.

RESULTS

Discontinuation of AEDs resulted, to a greater extent than continued treatment, in a slight improvement in symptoms of depression and irritability. Comparable results were achieved in the subgroup taking carbamazepine. For patients with a high degree of depressive and somatic symptoms at baseline, no significant differences in symptoms emerged in the withdrawal group compared with the non-withdrawal group.

CONCLUSION

The results suggest that seizure-free patients with epilepsy on monotherapy can obtain a slight improvement in symptoms characteristic of depression and irritability if they discontinue treatment with AEDs. The described changes are limited, and the functional impact is of uncertain significance.