(550) Comparison of stress-coping, quality of life and alexithymia in patients who developed psychogenic non-epileptic seizures (PNES) at a younger vs. older age of onset

Rationale: Alexithymia and diminished quality of life (QOL) have been identified in persons with psychogenic non-epileptic seizures (PWPs). Difficulties with stress coping are also relatively frequent in this population. The average age for the development of PNES is between 20 and 40 years.  The purpose of this study was to compare PWPs who were diagnosed with PNES at less than 49 years of age with those who were diagnosed at 50 or older.

Methods: This is a retrospective study of 57 patients (50 women, 7 men) who developed PNES (2009 to 2020) at 50 + years and 78 patients (65 women, 13 men) who developed PNES at less than 50 years of age (2010 to 2020). The diagnosis of epilepsy or PNES was confirmed with video EEG. All patients were administered the Coping Inventory for Stressful Situations (CISS), the Toronto Alexithymia Scale (TAS), and the Quality of Life in Epilepsy-31 (QOLIE-31).  Demographic (age, occupational and relationship status) data were collected by a neuropsychologist. 

Results:  Both groups had equally low scores on QOLIE Emotional Wellbeing, Energy/fatigue, and Total QOL subscales. Those with an older age of onset had similarly elevated rates of trauma/adversity exposure (63%) and unemployment/disabled status (72%) as patients who developed PNES before 50 years (trauma: 72% and unemployed/disabled: 62%). However, PWPs with younger age of onset reported significantly higher use of Emotional (x̄ =56.6, SD13.83) and Avoidance (x̄ =51.54, SD11.28) coping strategies as compared to older PWPs on Emotional (x̄ =51.88, SD12.89) t(-1.95091), p=.02 and  Avoidance (x̄ = 45.52, SD12.62) t(-2.74151), p=.003.  Younger patients also reported a significantly higher seizure frequency (x̄ =0.78, SD1.38) than older patients (x̄ =0.29, SD0.62) t(-2.85865)  p= .002 and longer duration of PNES.

Conclusions: Patients who developed PNES at an older age are similar to those who had a younger seizure onset age in the risk factor of exposure to life adversities and also seem equally negatively impacted on occupational status. However, PWPs with PNES onset at a younger age appear to differ from the other group on seizure frequency and report using less efficient stress-coping strategies (emotional and avoidance). Predominantly ineffective stress-coping strategies and the longer duration of PNES may be associated to greater seizure frequency and would benefit from further inquiry. Higher use of Emotion and Avoidance-based coping strategies may represent a potential treatment target. Future studies will be necessary to further understand the subgroup who develop PNES at an older age. In conclusion, there appear to be identifiable differences in PWPs who develop PNES at a younger or older age.

Funding: Please list any funding that was received in support of this abstract.: None
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