Patient's and Neurologist’s Perception of Epilepsy and Psychogenic Non-epileptic Seizures

In the January issue of early view of the journal Epilepsia, Drs. Whitehead and colleagues from the UCLH-NHS Foundation Trust in the United Kingdom, as well as the Department of Clinical Neurophysiology and the Academic Neurology Unit in Sheffield UK, present an analysis to assess how do physicians and patients view seizures versus psychogenic non-epileptic spells. This is an important issue because how physicians view certain medical conditions can result in sending unwarranted signals that may not help the therapeutic process, particularly when it comes to trust and finding a solution for treating seizures and nonepileptic events.

Thirty-four (34) patients with epilepsy and 40 patients with psychogenic non-epileptic events along with 45 neurologists were recruited for participation in this study. All patients completed versions of an illness perception questionnaire adapted for epileptic or non-epileptic seizures. In addition, they completed a single item symptom attribution question set, hospital anxiety and depression scale, QOLIE 31 and Liverpool seizure severity scale. Participating neurologists completed two versions of the illness perception questionnaire revised and two symptom attribution questions for both epileptic and non-epileptic seizure disorders. The researchers went on to assess the differences in illness perceptions between patients with epilepsy and patients with PNES. They found that the differences in these perceptions were minor compared to those between patients with either seizure disorder and neurologists. Neurologists considered both seizure disorders more treatable and more amenable to personal control than did the patients themselves. Neurologists also had more polarized views of the etiology of both conditions whereas patients mostly considered the causes of their seizure disorders as partially physical and partially psychological, whereas neurologists perceived epilepsy as essentially physical and psychogenic non-epileptic event as clearly psychological. The investigators concluded that there are considerable differences between illness perceptions of patients with seizure disorders and their doctors which could represent barriers to successful clinical management. In particular, a discrepancy between neurologist and patient beliefs about personal control that patients may be able to exert over psychogenic events could contribute to the confusion that occurs after the diagnosis has been explained to them. Furthermore, patients endorsement of physical causes for psychogenic events may reflect an unrealistic faith in the effectiveness of physical treatments and could be a source of tension between patients and physicians medical relationships, particularly when neurologists attempt to stop anti-seizure drugs or refer patients for psychological interventions.

The results from this study are somewhat intuitive yet it serves as an important reminder as to how physicians view illnesses can have a potential impact with regards to how patients ultimately fare. Although the patient/physician relationship was not studied in this evaluation, it is no surprise that this misperception between what’s physical, psychological, what can be controlled or not could result in tension and conflict that can harm the patient/physician relationship. This study is warning sign that we must all be careful of our own inherent biases and must do better in terms of explaining to patients what is under our own control and what is not.