Abstracts

Rationale: We evaluated the utility of neuropsychological scales measuring dissociative experiences and self-efficacy as a potential tool for differentiating patients with epilepsy (ES) from those with psychogenic nonepileptic seizure (PNES) events at Emory University Hospital (EUH). Considering that PNES spells are viewed as a maladaptive response to stress, we expected our results to illustrate that patients with PNES have higher scores of dissociation and lower levels of self-efficacy compared to ES. A secondary goal was to assess the rates of trauma history in each group with the expectation that the PNES group would have a greater number of personal experiences of trauma. We predicted that trauma would serve as a moderator for dissociation rates within our PNES population.Methods: This was a retrospective review of 114 adult patients undergoing inpatient video-EEG monitoring at EUH. Patients with either PNES events (n=22) or mixed PNES and ES (n=7) were grouped together. Patients who experienced only epileptic seizures were denoted as ES (n=75). Level of dissociative experience and level of self-efficacy were measured using the 28-Item Dissociative Experiences Scale (DES-28) and the 10-item Self-Efficacy Scale (SES) respectively and evaluated using nonparametric tests of two independent samples. Patients who completed the DES-28 were divided into two groups (history of trauma (n=28) and trauma naïve (n=70) without regard to diagnostic status. Nonparametric tests of two independent samples were performed to examine the effect of trauma on dissociation. Finally, a standard independent sample t-test was performed to examine the effect of diagnosis on dissociation within the smaller population of trauma survivors (n=28). Trauma was defined based on the results of a structured clinical interview, and could reflect sexual, physical, and/or emotional abuse as perceived by the patient.Results: The mean total scores for dissociation were shown to be significantly greater for patients with PNES events versus ES (p<.01). As expected, ES patients scored significantly higher for levels of self-efficacy than PNES patients (p<.05). Patients with a history of trauma had significantly higher ratings of dissociative experiences than the trauma naïve group (p=.01). Finally, the PNES trauma group (n=15) exhibited significantly higher levels of dissociation compared with the ES trauma group (n=13; p=.001).Conclusions: PNES patients exhibited higher rates of dissociation and lower rates of self-efficacy compared to their ES counterparts, and were much more likely to have experienced trauma. As expected, patients with a positive trauma history had a higher rate of dissociative experiences irrespective of diagnosis, yet those with a PNES diagnoses had significantly higher rates of dissociation than those with ES. This suggests PNES patients may have a unique manner of processing traumatic experiences, which could explain this sustained difference in dissociation levels.