Differences in illness perceptions between patients with non-epileptic seizures and functional limb weakness

Abstract

Word Count excluding abstract and tables: 1590Abstract 259 Abstract ObjectivesIllness perceptions are considered to play an important role in the onset and maintenance of symptoms in Functional Neurological Symptom Disorder (Conversion Disorder). There has, however, been little work examining differences between subtypes of this disorder. We therefore aimed to compare illness perceptions of patients with non-epileptic seizures (NES) and those with functional weakness (FW) with matching neurological disease controls to examine their specificity. MethodsThe Illness Perception Questionnaire Revised (IPQ-R) was completed by patients with functional limb weakness, non-epileptic seizures and patients with neurological disease causing limb weakness and epilepsy in two separate case control studies. ResultsPatients with FW (n=107), NES (=40), Epilepsy (n=34) and neurological disease causing limb weakness (NDLW) (n=46) were included in the analysis. Both FW and NES patients reported a low level of personal control, understanding of their symptoms and a tendency to reject a psychological causation of their symptoms. However NES patients rejected psychological causes less strongly than FW patients (p<0.01), including the single 'stress' item of the IPQ-R (p<0.01). Patients with NES were also more likely to consider their treatment to be more effective (p<0.01). None of these differences appeared in a similar comparison between patients with epilepsy and patients with NDLW. ConclusionAlthough patients with NES tend, as a group, to reject psychological factors as relevant to their symptoms, they did so less strongly than patients with functional limb weakness in these cohorts. This has implications for both the way in which these symptoms are grouped together but also the way in which explanations and treatment is approached.

Towards an integrative theory of psychogenic non-epileptic seizures (PNES)

“…However, we also suggest that the rapid, paroxysmal and often acutely frightening nature of PNES means that they are more likely to be accompanied (and triggered) by symptoms of hyper-arousal than other FNS (although increased arousal may also be apparent in the early stages of other sudden-onset symptoms; Pareés et al, 2012). Indeed, this may explain why patients with more continuous FNS are even less likely to perceive their problem as 'emotional' than patients with PNES (Ludwig, Whitehead, Sharpe, Reuber, & Stone, 2015). This panic-like surge in arousal will also feed into the seizure scaffold, influencing how sensory and emotional information is processed during the ictus and creating a platform for non-epileptic events that share some of the subjective characteristics of hyper-arousal, but without the underlying physiological changes.…”

Psychological and psychiatric aspects of psychogenic non-epileptic seizures (PNES): A systematic review

“…However, there are some differences between patients with PNES and other functional symptoms that could have a bearing on mechanism (e.g., Guz, Doganay, Ozcan et al 2003;Driver-Dunckley et al, 2011;Ludwig, Whitehead, Sharpe, Reuber & Stone, 2015), which should be considered in future research. Almost none of the studies in this area have evaluated whether physical symptoms serve a psychological function for patients.…”

The prognosis of functional limb weakness: a 14-year case-control study

“…Healthy control subjects, without neurological disease or limb weakness, were asked to take part when they visited their GP for a cervical smear, an oral anticonceptive health check or a minor upper respiratory tract infection. Four studies have been published on the baseline data (Stone et al, 2010(Stone et al, , 2012bLudwig et al, 2015;Whitehead et al, 2015).…”