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Joshua I. Breier, PhD; Kathleen L. Fuchs, MS; Bonnie L. Brookshire, PhD; James Wheless, MD; Azreena B. Thomas, MD; Jules Constantinou, MD; L. James Willmore, MD

Arch Neurol. 1998;55:660-665.

Objectives  To contrast and compare self-reported quality of life in patients with intractable epilepsy and pseudoseizures and to examine the relationship between self-reports and objective measures of cognitive functioning in both of these groups.

Design  Case series using profile analysis and analysis of covariance.

Setting  University epilepsy surgery program.

Participants  Forty-three patients with intractable complex partial seizures of unilateral temporal lobe origin and 25 patients with pseudoseizures.

Measures  Quality of Life in Epilepsy Inventory-89; neuropsychological tests assessing verbal memory, nonverbal memory, naming, and attention; and the Depression Scale (2) of the MMPI-2 (Minnesota Multiphasic Personality Inventory).

Results  Patients with pseudoseizures described themselves as more limited in the physical health domain than patients with complex partial seizures. Self-perceptions of cognitive functioning were similar between groups, despite the superior performance of patients with pseudoseizures on objective measures. Self-perception of cognitive dysfunction was related to mood disorder in the pseudoseizure group only, and there were no relationships between subjective and objective measurements of cognitive status within this group independent of mood disorder. For the complex partial seizures group, relationships between subjective and objective measures of cognitive function were dependent on the side of seizure onset.

Conclusions  Results are consistent with hypotheses that suggest that patients with pseudoseizures focus on physical rather than psychological explanations for stress, and that this focus is related, at least in a subgroup of patients, to mood disorder. Results also provide support for the validity of the Quality of Life in Epilepsy Inventory-89 in populations with intractable seizure disorder, although there is evidence for a possible floor effect on some of the subscales.

From the Departments of Neurosurgery (Dr Breier and Ms Fuchs), Neurology (Drs Brookshire, Wheless, Thomas, Constantinou, and Willmore), and Pediatrics (Dr Wheless), Texas Comprehensive Epilepsy Program, University of Texas Health Science Center, Houston.

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