Abstracts

Rationale: Patients with NEPS usually present to the emergency departmentsrather than to outpatient neurology clinics because of the duration of the events. They usually present with dramatic and unrelenting events resemblingstatus epilepticus. These events, while non-epileptic, are frequently treated with antiepileptic drugs. While differences in clinical presentations between PNES and NEPS patients have been observed(Dworetzky et al., 2010),the differences in psychological functioning between these groups have not been explored.Methods: All patients admitted to the epilepsy monitoring unit (EMU) at UAB between 2/1/13 and 10/1/13 were approached for participation before diagnosis was established. 70 patients consentedto participate (11 with PNES, 11 with NEPS, 30 with epilepsy (ES) and 15 with mixed diagnoses; 3 had non-diagnostic evaluations). Patients completed self-administered questionnaires: Toronto Alexithymia Scale (TAS), Barret Impulsivity Scale (BAS), Screening for Somatoform Disorders- 7 (SOMS-7), Personality Assessment Inventory (PAI), Childhood Trauma Questionnaire (CTQ) and Quality of Life in Epilepsy Inventory (QOLIE-89). Only data collected prior to patients receiving their diagnosis were analyzed. Independent samples t-test was used to compare the groups; correction for multiple comparisons was not performed due to the exploratory nature of the study.Results: The following group comparisons were made: ES:PNES, ES:NEPS, ES:(PNES/NEPS combined) and PNES:NEPS.Compared to ES, PNES patientswere found to have more symptoms of mania(PAI/mania/subscaleactivity level p=0.012), more antisocial features (PAI/antisocial/subscale antisocial behavior p=0.042), and more paranoia (PAI paranoia scale p=0.029). Compared to ES,NEPS had more mania (PAI/mania/subscale irritability p=0.006), antisocial features (PAI/antisocial/subscale stimulus seeking p=0.011), were more impulsive and less attentive (BAS-T p=0.011/BAS-ATT p=0.047), were more likely to have a history of childhood trauma (CTQ emotional abuse p=0.053; CTQ sexual abuse p=0.007; CTQ emotional neglect p=0.013). Differences between ES and the combined group of PNES/NEPS include higher mania scores (PAI/mania/subscale irritability p=0.01) higher levels of antisocial behavior (PAI antisocial behaviors scale p=0.066), and higher levels of childhood trauma (CTQ emotional abuse p=0.036/CTQ emotional neglect p= 0.039). Finally, patients with NEPSwhen compared to PNES tended to have higher impulsivity (BAS p=0.06), higher mania scores (PAI mania scale p=0.065), higher paranoia scores (PAI paranoia scale p=0.057), and higher incidence of childhood abuse (CTQ sexual abuse p<0.001).Conclusions: Our data confirm the overall lower psychosocial functioning in patients with PNES/NEPS compared to patients with ES. In addition, previously not reported lower psychosocial functioning of patients with NEPS compared to PNES was found. Thesefindings support the need to further explore differences between NEPS and PNES for possible interventions.