Cognitive impairment is not equal in patients with epileptic and psychogenic nonepileptic seizures

被引:91
作者
Drane, Daniel L.
Williamson, David J.
Stroup, Elizabeth S.
Holmes, Mark D.
Jung, Matthew
Koerner, Erich
Chaytor, Naomi
Wilensky, Alan J.
Miller, John W.
机构
[1] Univ Washington, Harborview Med Ctr, Reg Epilepsy Ctr, Neuropsychol Lab, Seattle, WA 98104 USA
[2] Univ Washington, Sch Med, Dept Neurol, Seattle, WA 98195 USA
[3] Ortho McNeil Janssen Sci Affairs LLC, Mobile, AL USA
[4] Univ S Alabama, Dept Neurol, Mobile, AL 36688 USA
关键词
psychogenic nonepileptic seizures (PNES); epilepsy; symptom validity testing; cognitive functioning;
D O I
10.1111/j.1528-1167.2006.00611.x
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Purpose: Patients with psychogenic nonepileptic seizures (PNES) and those with epileptic seizures (ES) purportedly have roughly equal neurocognitive deficits. However, recent findings suggest that patients with somatoform disorders exhibit more variable effort on neurocognitive testing than do controls. We reexamined neurocognitive function in patients with ESs and PNES by using symptom validity testing to control for variability in effort. Methods: Patients referred for video-EEG monitoring were administered the Word Memory Test (WMT), a measure of symptom validity, as part of neuropsychological evaluation. Patients classified with ictal video-EEG recordings as having ES (n = 41) or PNES (n = 43) were compared on neurocognitive and WMT performance and demographic, psychiatric, and medical variables. Results: Striking rates of WMT failure were observed in the PNES (51.2%) group, but not in the ES (8.1%) group (p = < 0.001) after controlling for false-positive errors. Although the PNES and ES groups reported equivalent neurologic histories, the PNES group exhibited less objective evidence of impairment as measured by valid neuropsychological testing, MRI of the brain, and video-EEG monitoring. Conclusions: Many patients with PNES do not put forth maximal effort during neuropsychological assessment. When patients with PNES put forth valid effort, they demonstrate less objective evidence of neuropathologic injury or disease than do patients with ES. The cognitive impairment reported by this group appears to be more a function of motivational (although not necessarily intentional) factors than of verifiable neuropathology.
引用
收藏
页码:1879 / 1886
页数:8
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