Seizure semiology in males with psychogenic nonepileptic seizures is associated with somatic complaints

Abstract

Aims: Psychopathology has been studied in patients with epileptic or psychogenic non-epileptic seizures in the context of diagnosis and treatment. Unfortunately, most PNES studies include few males and do not consider possible gender differences, making findings less generalizable to males with PNES. In this study we specifically compare males with PNES to females with PNES and to males with epilepsy.

Methods: Males with PNES (n=58), males with epilepsy (n=86), females with PNES (n=147), and females with ES (n=142) were evaluated on an inpatient epilepsy monitoring unit. Self-reported objective measures of psychopathology, demographics, and PNES seizure semiology were compared.

Results: Personality Assessment Inventory profiles revealed marked differences, particularly in somatic symptoms, between PNES and epilepsy. Females with PNES had higher levels of physiological depressive symptoms but lower antisocial features. Males with PNES who had clinically significant elevations on the somatic complaints scale were much more likely to have motor seizures while females with PNES classified similarly were equally likely to have either motor or non-motor events.

Conclusion: Gender difference in PNES seizure semiology was associated with whether or not clinically significant somatic symptoms were present; males with elevated somatic symptoms were much more likely to have motor PNES. However, we did not find evidence of greater psychopathology in males with PNES compared to females with PNES. Gender differences in the behavioral manifestation of PNES in the context of presence or absence of somatization may have implications for diagnosis and treatment.

Keywords: Gender differences; Non-epileptic; Psychogenic; Somatization.