Distinguishing between psychogenic and organically-based seizures : the search for critical psychological variables.

Abstract

Differentiating between organic epilepsy and psychogenic pseudoseizures is a difficult task even for experienced practitioners . Both disorders present in a similar manner and at present there are no clinical signs that distinguish between them. Latrogenesis may occur when psychogenic seizures are treated medically and sometimes aggressively in order to control seizure activity. Quality of life is negatively impacted on in both patient groups and stigmatisation and social isolation frequently occur. Psychiatric comorbidity is associated with both epilepsy and psychogenic seizures. The primary aim of this study was to explore the possibility of finding a definitive means of discriminating between the two patient groups. This study assessed quality of life and psychiatric dysfunction in both patient groups using the QOLIE-31 and the SCL-90-R instruments, respectively. The Seizure Questionnaire was used to assess qualitative aspects. The sample (n = 19) was made up of 10 females and nine males with a mean age of 30.6 years (S D = 8.9, range l8 - 44 years). One case of mixed seizures was excluded. The sample was taken from an epilepsy monitoring unit in a hospital in Durban, South Africa. On the scales of the SCL-90-R, Anxiety showed significant difference between groups and on the QOLIE-31 scales, Energy/Fatigue, Cognitive Functioning and Overall score showed significant differences. These differences were in the expected direction as found in previous research i n the literature. These trends need to be interpreted cautiously given the sample size.