Abstracts

RATIONALE: Trauma histories have been consistently identified as a major risk factors for non-epileptic seizures (NES). Far less is understood regarding the role of developmental and biologic substrates of NES. Neuroimaging correlates of other psychiatric disorders, as well as other forms of conversion, suggest neurologic underpinnings of NES may exist. Its etiology is elusive and there remains considerable symptom and risk overlap with epileptic seizures (ES). Developmental vulnerabilities and other forms of neurologic compromise may provide fertile ground to the expression of NES in later life. The purpose of this study was to compare patient self-report of developmental and select neurologic histories in patients with v-EEG confirmed NES and ES. Participants should be able to identify basic features, known and suspected risk factors of adult-onset NES.
METHODS: Responses of 34 NES patients to a comprehensive background history questionnaire were compared with age and education-matched patients with ES. All underwent diagnostic inpatient video-EEG monitoring to characterize the nature of spells and seizures.
RESULTS: There were no group differences in gender distribution, mean age or education. Twenty-one percent of NES patients carried a formal diagnosis of ADD or ADHD while in school; no ES patient in this sample reported this history ([chi]2=.03). Approximately one-third of NES patients reported a childhood history of difficulty interpreting others[ssquote] emotions, while fewer than 10% of ES patients endorsed this problem ([chi]2=.05). Both family and personal history of severe headache or migraine were common in NES (62% and 82%, respectively). Comparatively fewer ES patients reported family or personal history of headache (41% and 25%; [chi]2=.01,[chi]2=.002, respectively). No statistically significant group differences emerged, however, in patients[ssquote] self-report of developmental delays (e.g. walking, language), formal diagnosis of learning disability, or school failure. Although experiencing more difficulty interpreting others[ssquote] emotions during childhood, NES patients did not perceive any greater childhood difficulty expressing their own emotional states and needs as compared to patients with ES.
CONCLUSIONS: Patients with NES may possess vulnerabilities during childhood and adolescence which predispose expression of the disorder in a manner similar to that proposed by diathesis stress models. Neurologic underpinnings associated with ADD/ADHD, headache and familial history of headache may play a meaningful role in the emergence of somatization disorders in adulthood. Review of such factors may be useful as part of a comprehensive clinical workup and may further guide therapeutic intervention.