Abstracts

Patients with non-epileptic psychogenic seizures (NES) frequently have affective disorders, anxiety disorders and personality disorders. Further, the presence of personality disorders in NES patients is associated with intractability. However, the personality disorders of NES patients that impair coping skills and contribute to the occurrence of NES are not fully understood. We sought to determine the type of personality disorders associated with NES patients compared to epilepsy patients by prospectively evaluating adult patients admitted for video-EEG., Consecutive adult patients admitted to the hospital for video-EEG monitoring found to have NES were studied; the epilepsy comparator group was derived using a simultaneously admitted patient with findings on video-EEG confirming the diagnosis of epilepsy. No patients who had findings of both disorders on video-EEG were studied. Patients who could communicate in English and without significant cognitive impairment were included. Personality was assessed using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Personality disorders were then divided into personality clusters described in the DSM-IV, which are based on functional status: A (paranoid, schizotypal, schizoid), B (borderline, histrionic, antisocial, narcissistic) or C (avoidant, dependent, obsessive-compulsive)., Sixteen NES subjects were studied, 15 were women. Sixteen epilepsy subjects were studied, 10 were women. Three subjects in the NES group had no personality disorder, compared to four in the epilepsy group. Twelve subjects in the NES group met criteria for either Cluster A or B type personality disorders, or both, compared to six in the epilepsy group. However, only one NES patient met criteria for Cluster C personality disorder, compared to six in the epilepsy group. The distribution of having a Cluster A and/or B personality disorder compared to Cluster C or no personality disorder was significantly different between NES and epilepsy groups (chi-square p=0.03)., NES patients are more likely meet criteria for a personality disorder that is more dysfunctional, in the Cluster A or B group, compared to epilepsy patients, who are more likely to have Cluster C personality disorders, predominantly obsessive-compulsive and avoidant. We suggest that the Cluster A or B personality features contribute to the occurrence of NES, while Cluster C behaviors in epilepsy patients may be in part a reaction to the experience of having chronic recurrent seizures.,