Psychiatric and psychological assessment of Spanish patients with drug-resistant epilepsy and psychogenic nonepileptic seizures (PNES) with no response to previous treatments

Pau Sobregrau; Eva Baillès; Mar Carreño; Antonio Donaire; Teresa Boget; Xavier Setoain; Núria Bargalló; Jordi Rumià; María V Sánchez Vives; Luís Pintor

doi:10.1016/j.yebeh.2023.109329

Psychiatric and psychological assessment of Spanish patients with drug-resistant epilepsy and psychogenic nonepileptic seizures (PNES) with no response to previous treatments

Epilepsy Behav. 2023 Aug:145:109329. doi: 10.1016/j.yebeh.2023.109329. Epub 2023 Jul 13.

Authors

Affiliations

¹ Faculty of Psychology, University of Barcelona (UB), Barcelona 08007, Spain; Department of Psychiatry, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain. Electronic address: psobresa7@alumnes.ub.edu.
² Health Psychology Unit, Psychiatry Department, Vall d'Hebron, Barcelona 08035, Spain.
³ Clinical Institute of Neurosciences, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain; Epilepsy Unit, Neurology Department, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), University Hospital Clinic of Barcelona, Barcelona 08036, Spain.
⁴ Clinical Institute of Neurosciences, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain; Epilepsy Unit, Neurology Department, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain.
⁵ Biomedical Research Institute August Pi i Sunyer (IDIBAPS), University Hospital Clinic of Barcelona, Barcelona 08036, Spain; Department of Cognition, Development and Educational Psychology, Faculty of Psychology, University of Barcelona (UB), Barcelona 08007, Spain.
⁶ Department of Psychiatry, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain; Clinical Institute of Neurosciences, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain; Epilepsy Unit, Neurology Department, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), University Hospital Clinic of Barcelona, Barcelona 08036, Spain.

PMID: 37453292
DOI: 10.1016/j.yebeh.2023.109329

Abstract

Objective: Psychogenic nonepileptic seizures (PNES) are common imitators of epileptic seizures. Refractoriness to antiseizure medication hinders the differential diagnosis between ES and PNES, carrying deleterious consequences in patients with PNES. Psychiatric and psychological characteristics may assist in the differential diagnosis between drug-resistant epilepsy (DRE) and PNES. Nevertheless, current comprehensive psychiatric and psychological descriptive studies on both patient groups are scarce and with several study limitations. This study provides a comprehensive psychiatric and psychological characterization of Spanish patients with DRE and PNES.

Method: A cross-sectional and comparative study was completed with 104 patients with DRE and 21 with PNES. Psychiatric and psychological characteristics were assessed with the HADS, SCL-90-R, NEO-FFI-R, PDQ-4+, COPE, and QOLIE-31 tests. Parametric and non-parametric tests were used, and regression models were fit to further explore factors affecting patients' life quality.

Results: Patients with PNES had greater levels of somatization and extraversion and were associated with benzodiazepine intake. Patients with DRE showed greater narcissistic personality disorder symptoms than those with PNES. In patients with DRE, difficulty in performing basic needs-related tasks and greater psychological distress severity and seizure frequency were associated with poorer life quality. In contrast, being a woman, having a psychiatric disorder history, and greater psychiatric symptoms' intensity were associated with poorer life quality in patients with PNES.

Conclusion: Patients with DRE and PNES share similar psychiatric and psychological characteristics, with only very few being significantly different.

Keywords: DRE (Drug-Resistant Epilepsy); Epilepsy; PNES (Psychogenic nonepileptic seizures).

MeSH terms

Conversion Disorder* / psychology
Cross-Sectional Studies
Drug Resistant Epilepsy*
Electroencephalography
Epilepsy* / complications
Epilepsy* / diagnosis
Epilepsy* / drug therapy
Female
Humans
Psychogenic Nonepileptic Seizures
Seizures / diagnosis
Seizures / drug therapy
Seizures / psychology