Eye-opening behaviors help diagnose nonepileptic seizures
New techniques supplement traditional methods.
Family and patient traits. Studies comparing family functioning in patients with ES and PNES reveal:
- individuals with PNES view their families as more dysfunctional, particularly in regard to communication23
- family members of patients with PNES reported difficulties defining roles23
- patients with PNES score higher on measures of somatic complaints when compared with other seizure patients.24
Pain disorders are also common in patients with PNES. Among epilepsy clinic patients, a diagnosis of fibromyalgia or chronic pain has an 85% positive predictive value for PNES.25
Neuropsychological measures. A number of studies describe the cognitive, emotional, personality, and psychomotor differences between ES and PNES cohorts (Table 2).26-29 Patients with ES and PNES perform about the same on neuropsychological measures but worse than healthy controls. Patients with PNES appear to suffer from cognitive and somatic distress and anxiety. Studies reveal they also have difficulties expressing this distress to family members and others.
Table 2
Neuropsychological (NP) differences between PNES and ES
| Feature | Differences |
|---|---|
| Cognitive ability | Patients with ES and PNES show no significant differences on tests of intelligence, learning, and memory but score lower than healthy control subjects26 |
| Psychomotor skills | Patients with PNES show reduced motor speed and grip strength, compared with healthy controls27 |
| Motivation | Patients with PNES score lower on motivational measures than ES patients, perhaps reflecting a lack of psychological resources necessary to persist with a challenging NP battery; frank malingering is thought to occur rarely in PNES28 |
| Personality | Minnesota Multiphasic Personality Inventory (MMPI-2) studies show elevations in hypochondria, hysteria, and depression scores in patients with PNES29 |
