(1) To measure depressive and dissociative symptoms in a population of patients with Non-Epileptic Seizures (NES, or pseudo-seizures); (2) To compare NES with Epileptic subjects and Normal controls; (3) To try to define a personality profile specific, or typical, of NES patients.
Patients: 30 consecutive patients (21 females and 9 males, mean age 32.9+/-11.7 years) with NES diagnosed on clinical basis and confirmed by video-EEG recording; 30 patients with epilepsy matched for age and sex who had presented at least two seizures in the 12 months prior to the study despite pharmacological treatment; 30 Control subjects, healthy volunteers, matched for age and sex. Psychometric evaluation: Hamilton Rating Scale for Depression (HDRS), Dissociative Experience Scale (DES), Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Groups were compared by means of one-way Analysis of Variance (ANOVA) for independent samples, followed by posthoc Tukey HSD Test, with Bonferroni correction for multiple comparisons.
Depressive and dissociative symptoms showed a significantly higher prevalence in the NES group as compared to Epileptics (p<0.001) and Controls (p<0.001), whereas patients with epilepsy did not differ from Controls. The analysis of the MMPI-2 in NES group showed a general increase in most MMPI-2 T-scores as compared to Epileptics and Controls, rather than a constant elevation (T-score>70) of one or more scales. No specific personality profile could be identified for the NES group.
Our results are consistent with the hypothesis that depression and dissociative mechanisms are important precursors to the development and expression of NES.
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"This may partially be a reflection of age-related traits. In both the group with epilepsy and nonclinical group, with age advancing, the DES indices decreased significantly, consistent with the previous observations in the general population [14,23,32] . Furthermore, as age advances , seizure frequency tends to decrease and its related adversities may also decrease. "
"Such difficulties are often thought to stem from maladaptive attachments with early caregivers, which undermine the development of appropriate ways of understanding and relating to emotional states in oneself and others . Despite the apparent popularity of such concepts, several studies with groups with PNESs have failed to replicate the conversion V profile on the MMPI [12,13], and the few published studies on alexithymia in PNESs have not demonstrated higher levels of alexithymia in these patients compared with those with epilepsy [10,14]. One possibility is that these mixed findings reflect the heterogeneity of patients with PNESs in terms of etiology and comorbid psychopathology. "
[Show abstract][Hide abstract]ABSTRACT: Psychogenic nonepileptic seizures (PNESs) are poorly understood and difficult to treat. Research and theory suggest that problems with recognizing, acknowledging, and regulating emotional states (i.e., emotional dysregulation) may contribute to the development and maintenance of PNESs. However, there is a lack of well-controlled studies using dedicated measures of emotional regulation with patients with PNESs. The current study sought to address this gap.
Forty-three patients with PNESs and 24 with epilepsy completed a postal survey comprising measures of emotional dysregulation (Difficulties in Emotion Regulation Scale), alexithymia (Toronto Alexithymia Scale), attachment (Relationship Scales Questionnaire), and psychopathology (Generalized Anxiety Disorder-7; Patient Health Questionnaire-9; Somatoform Dissociation Questionnaire-20). Cluster analysis was used to identify possible subgroups of patients with PNESs characterized by distinct patterns of emotional dysregulation.
Two clusters of patients with PNESs were identified. The first (n=11) was characterized by higher levels of psychopathology, somatization, alexithymia, and difficulties with most aspects of emotional regulation (including identifying, accepting, and describing feelings, accessing adaptive regulatory strategies, performing goal-directed behaviors, and controlling feelings and actions) compared with the group with epilepsy. The second (n=32) was characterized by relatively high somatization and depression scores but comparatively normal levels of alexithymia and emotional regulation.
The findings suggest that patients with PNESs can be divided into at least two meaningful subgroups characterized by distinct psychological profiles, only one of which is characterized by significant problems with emotional dysregulation. Further research is needed to determine whether the relatively normal emotional dysregulation and high somatization scores of some patients with PNESs are due to emotional avoidance or more basic problems with perceptual and behavioral control.
Full-text · Article · Aug 2013 · Epilepsy & Behavior
[Show abstract][Hide abstract]ABSTRACT: We have successfully demonstrated a tunable dual-wavelength fiber laser based on unique 2<sup>nd</sup> order Sagnac-Lyot filters. These filters provide absolute wavelength tuning, channel spacing tuning and stable dual-wavelength lasing.