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Dissociation in Temporal Lobe Epilepsy and Pseudo-Epileptic Seizure Patients

KUYK, JARL M.A.1; SPINHOVEN, PHILIP Ph.D.2; VAN EMDE BOAS, WALTER M.D., Ph.D.1; VAN DYCK, RICHARD M.D., Ph.D.3

The Journal of Nervous & Mental Disease: December 1999 - Volume 187 - Issue 12 - p 713-720
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Patients with epileptic seizures (ES) and especially those with temporal lobe epilepsy (TLE) share many symptoms with patients with pseudo-epileptic seizures (PES), and the differentiation between them is often difficult. There is growing evidence that a subgroup of PES patients suffer from a dissociative disorder. It is recognized that dissociative symptoms pertain to both psychological and somatoform components of experience. Questionnaires assessing dissociation might provide positive criteria for the diagnosis of PES. In this study, the Dissociation Questionnaire (DIS-Q) and the Somatoform Dissociation Questionnaire (SDQ-20) were administered to patients with ES (TLE, non-TLE) and PES. To control for the influence of general psychoneurotic complaints, the SCL-90 was administered. Apart from this, answers on a trauma questionnaire were related to the diagnosis. Results showed that PES patients scored significantly higher on the SDQ-20, also after correction with the SCL-90, and no difference was found on the DIS-Q. Also, PES patients significantly more often reported sexual traumatic experiences. A logistic regression revealed that results on the SDQ-20 have no independent value in addition to the contribution of gender, age, age at seizure onset, and the presence of sexual abuse in the prediction of the diagnosis. In conclusion, somatoform and not psychological dissociative symptoms are characteristic for PES patients in comparison to ES patients. Other measures are needed within the framework of the differential diagnosis between PES and ES.

1 Stichting Epilepsie Instellingen Nederland, P.O. Box 21, 2100 AA Heemstede, The Netherlands. Send reprint requests to Jarl Kuyk.

2 Department of Clinical and Health Psychology, Leiden University, Leiden, The Netherlands.

3 Department of Psychiatry, Vrije Universiteit, Amsterdam, The Netherlands.

This study was supported by a grant (#97-02) of the Nationaal Epilepsie Fonds/De Macht van het Kleine, Houten, The Netherlands. We thank the colleagues of the Department of Psychotherapy of SEIN and especially Els de Graaf and Miranda Swinkels for their help in collecting data for this study.

© 1999 Lippincott Williams & Wilkins, Inc.