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Fox J, Bollig MK, Mishra M, Jacobs M. Neuropsychological characteristics of drug resistant epilepsy patients with and without comorbid functional seizures. Epilepsy Res 2024; 201:107340. [PMID: 38442550 DOI: 10.1016/j.eplepsyres.2024.107340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Neuropsychological testing is a mandatory component in the evaluation of drug resistant epilepsy. The results of testing may assist with both the localization of an epilepsy as well as assessment of surgical risk. Previous studies have demonstrated differences in the neuropsychological performance of patients with epilepsy and functional seizures. We hypothesized that comorbid functional seizures could potentially influence neuropsychological test performance. Therefore, we evaluated whether there is a difference in the neuropsychological test results between drug resistant epilepsy patients with and without comorbid functional seizures. METHOD Neuropsychological test results were compared between 25 patients with drug resistant focal epilepsy and 25 patients that also had documented functional seizures. Univariate analyses and multiple logistic regression models were used to both assess performance differences between the groups and to assess whether test results could be used to accurately identify which patients had comorbid functional seizures. RESULTS Epilepsy patients with comorbid functional seizures performed significantly worse on the FAS Verbal Fluency Test compared to ES patients (p = 0.047). Digit Span Backwards (p = 0.10), Digit Span Forwards (p = 0.14) and Working Memory Index (p = 0.10) tended to be lower in the epilepsy and functional seizures group but was not statistically significant. A multiple logistic regression model using the results of four neuropsychological tests was able to identify patients with comorbid functional seizures with 83.33% accuracy. CONCLUSIONS There are appeared to be some differences in the neuropsychological performance among drug resistant epilepsy patients based on whether they have comorbid functional seizures. These findings may have relevant implications for the interpretation of neuropsychological test results.
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Affiliation(s)
- Jonah Fox
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Madelyn K Bollig
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Murli Mishra
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Monica Jacobs
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, United States
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Yang T, Roberts C, Winton-Brown T, Lloyd M, Kwan P, O'Brien TJ, Velakoulis D, Rayner G, Malpas CB. Childhood trauma in patients with epileptic vs nonepileptic seizures. Epilepsia 2023; 64:184-195. [PMID: 36300720 PMCID: PMC10100454 DOI: 10.1111/epi.17449] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Childhood trauma has been implicated as a risk factor for the etiology of psychogenic nonepileptic seizures (PNES). Relatively little attention has been paid to whether profiles of specific trauma types differ between patients with epilepsy and PNES. Investigating childhood trauma profiles in these patient groups may identify psychological vulnerabilities that predispose to developing PNES, and aid early diagnoses, prevention, and treatment. METHODS Data were collected from two cohorts (nRetrospective = 203; nProspective = 209) admitted to video-electroencephalography (EEG) monitoring units in Melbourne Australia. The differences in Childhood Trauma Questionnaire domain score between patient groups were investigated using standardized effect sizes and general linear mixed-effects models (GLMMs). Receiver-operating characteristic curves were used to investigate classification accuracy. RESULTS In the retrospective cohort, patients diagnosed with PNES reported greater childhood emotional abuse, emotional neglect, physical abuse, sexual abuse, and physical neglect relative to patients with epilepsy. These differences were replicated in the prospective cohort, except for physical abuse. GLMMs revealed significant main effects for group in both cohorts, but no evidence for any group by domain interactions. Reported sexual abuse showed the best screening performance of PNES, although no psychometric scores were adequate as isolated measures. SIGNIFICANCE Patients with PNES report a greater frequency of childhood trauma than patients with epilepsy. This effect appears to hold across all trauma types, with no strong evidence emerging for a particular trauma type that is more prevalent in PNES. From a practical perspective, inquiry regarding a history of sexual abuse shows the most promise as a screening measure.
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Affiliation(s)
- Tianren Yang
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Caitlin Roberts
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Toby Winton-Brown
- Alfred Brain, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Psychiatry, Alfred Health, Melbourne, Victoria, Australia
| | - Michael Lloyd
- Alfred Brain, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Psychiatry, Alfred Health, Melbourne, Victoria, Australia
| | - Patrick Kwan
- Alfred Brain, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Alfred Brain, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Genevieve Rayner
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Alfred Brain, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Austin Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Charles B Malpas
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.,Alfred Brain, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Neuropsychological performance and effort in patients diagnosed with psychogenic nonepileptic seizures - Descriptive study of a Czech sample. Epilepsy Behav 2022; 128:108584. [PMID: 35131734 DOI: 10.1016/j.yebeh.2022.108584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of the study was to examine the neuropsychological performance and effort in patients with a confirmed PNES diagnosis. The second aim of the study was to investigate the relationship between validity indicators from the cognitive battery with validity and clinical scales from a personality scale. METHOD Patients with PNES (N = 250; F:M 186:64; mean age 38.32 (13.23)) were assessed utilizing the RBANS (Czech Research version) to evaluate cognitive performance and to obtain the Effort Index. The MMPI-2 was used to evaluate personality and psychopathology. RESULTS Global cognitive performance was 0.92 SD below average (according to the Gaussian distribution) in patients with PNES. The lowest scores in the sample were in the Attention domain (-1.7SD). Insufficient effort was detected in 10% of patients. Education correlated negatively with the Effort index (rs = -0.25, p = 0.01). A mild significant correlation in Scale 7 (rs = 0.21, p = 0.01) and Scale 8 (rs = 0.24, p = 0.01), and a significant correlation between Effort Index and Back F Scale (rs = 0.23, p = 0.01) were noted. CONCLUSIONS Assessment of cognitive performance and effort is an essential part of the comprehensive evaluation of patients with PNES during their hospitalization at Epilepsy centers. Many aspects of the neuropsychological assessment can offer useful indications for reaching a differential diagnosis, including clinical history, behavioral observations, cognitive and symptom validity testing, and structured psychological inventories.
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