Abstrakt
Introduction: Multifactorial etiology has been identified that may underlie the development and occurrence of PNES: a history of abuse and neglect, post-traumatic stress disorder, mood and personality disorders, malingering and cognitive impairment. Not all factors have the same type of impact.
A specific vulnerability may play a role in the development of PNES. Aims: The aim of this study is to monitor health and psychosocial factors at least one year after hospitalization at Epilepsy Monitoring Unit and after the communication of the PNES diagnosis.
We evaluate stressors and attachment in childhood, family background, traumatic events, personality and cognitive performance including effort. Materials and methods: Patients with PNES (125w/49m) were examined using semi-structured interview focused on the change in the frequency and severity of seizures, consumption of health care, changes in subjective quality of life in respect to the seizures.
Patients were assessed by RBANS, MMPI-II, a structured interview focused on the stressors in childhood, social learning and the stressors preceding seizures, and by emotional relationships in childhood questionnaire (PBI). Results: At least one year after hospitalization the frequency of seizures was significantly lower (p<.001) and the frequency of hospitalizations decreased.
Nearly 30% of patients suffered from persistent frequent seizures. We found higher frequency of stressors in childhood in comparison with control group.
General psychopathology (the majority of clinical scales in MMPI-II) was significantly increased against the norm. The cognitive performance in patients' group in comparison with healthy controls was significantly lower in all (p<.001).
The most reduced performance was in domains Attention and Delayed recall (below average). Conclusions: Multifactorial approach in the understanding of pathogenesis of PNES is essential for correct diagnosis.
Integral part of neuropsychological assessment is evaluation of history of traumatic events, post-traumatic stress disorder, mood and personality disorders, and cognitive impairment. Differential diagnosis of epileptic and psychogenic seizures is important for appropriate treatment.
Our results demonstrated seizures persistence and high levels of psychosocial, economical and health impacts. The relatively low percentage of change during one year supports the need for specialized interventions in this group of patients.