Abstracts

Rationale: Psychogenic nonepileptic seizures (NES) are more commonly diagnosed in women than men. This may reflect gender differences in the psychological adjustment of patients with NES vs. epilepsy (ES), and/or differences in psychological risk factors between men and women. Psychological profiles are often obtained as an adjunct to video EEG monitoring (VEEG) to distinguish patients with NES from those with ES. There has been one published study reporting gender differences on Minesota Multiphasic Personality Profile (MMPI)scores in patients with NES-- and the findings suggested greater maladjustment in the men with NES. We sought to replicate and extend those findings using a more current version of this widely used standardized test (i.e., MMPI-2) in a much larger consecutive series of patients. Methods: We retrospectively searched clinic database records to identify all adult patients who completed the MMPI-2 as part of a comprehensive seizure evaluation at Swedish Medical Center, and who received an unequivocal diagnosis of NES or ES based on VEEG monitoring of their typical spells. Patients with both NES and ES, or only subjective spells, were excluded. The final study sample included N=402 patients with NES (305 women, 97 men), and N=612 patients with ES (350 women, 262 men). T-tests were performed to determine statistically significant differences between the MMPI scores of male and female NES patients, and between the NES and ES groups, separately in each gender. We also examined the diagnostic accuracy of MMPI configuration rules that help identify patients who are more likely to have NES than ES. Results: Differences between the male and female NES patients were minimal. T-tests indicated no statistically significant difference on MMPI-2 Scales L, F, Hs, D, Hy, Pd, Mf, Pa, Pt, and Ma. However, MMPI scores of male NES patients were approximately 4 points higher than that of females on scales Sc (74.1 vs. 70.3, p=.03) and Si (57.0 vs. 53.5, p<.01), and 4 points lower on the K scale (47.1 vs. 51.5, p<.01). These small differences were overshadowed by wide separation between scores of the NES and ES subjects, that did not appear to vary by gender, and were maximal on the Hs and Hy scales, but also significantly elevated on scales F, D, Pd, Mf, Pa, Pt and Sc. Configural rules identified 81% of the female NES patients, and 75% of the male NES patients. Conclusions: Men and women with NES appear to exhibit similar patterns of psychological maladjustment on the MMPI, with both groups showing higher elevation on measures of physical health concerns and somatic complaints than patients with ES. Our findings indicate that men with NES may be slightly more likely to report oddities of thought or aberrant perceptual experiences than women with NES. The MMPI configural rules that may help identify patients with NES are only slightly less accurate in men than in women.