Epilepsy Information

American Epilepsy Society (Abst. 1.301)

Comparison of executive functions in patients with psychogenic non-epileptic seizures (PNES) and temporal lobe epilepsy (TLE) after controlling for malingering

Authors: L. Myers, M. E. Lancman, M. Lancman

The aim of this study was to compare executive functions in patients with psychogenic non-epileptic seizures (PNES) and temporal lobe epilepsy patients (TLE) after having excluded those who "failed" the Test of Memory Malingering. There are a growing number of reports that functional abnormalities are not distinctly restricted to the temporal lobe in TLE; executive function and working memory is also compromised (Stretton J & Thompson PJ, 2012). Deficits in working memory and executive functioning have also been reported in PNES (Chapman et al., 2011). Our hypothesis was that those with a diagnosis of PNES and TLE would exhibit deficits in executive functions and that no significant between- group difference would be evident.


The diagnosis of PNES and TLE was confirmed through video-EEG monitoring. Our standard neuropsychological battery included the Wechsler Abbreviated Sales of Intelligence (WASI), the Test of Memory Malingering (TOMM), the Trail Making, Color-Word Interference and Verbal Fluency subtests of the Delis Kaplan Executive Function System (DKEFS). Of 110 consecutive patients with the diagnosis of PNES, 97 were included. Seven who "failed" the TOMM, 3 who earned a

Of the 97 PNES patients, 14 were males and 83 females, mean age at the time of study was 39.3 ±1.2 years and mean education was 13.65 years ±.291. Of the 89 TLE patients, 31were males and 58 females, mean age was 45.0±1.7 and mean education was 12.82 years ±.302. Both groups evidenced impairments in all measures. Eighteen to 23 percent of patients with PNES and 22 to 30 percent of patients with TLE earned scores < 2 standard deviations below the mean on all three executive function subtests. No significant differences were found between PNES and TLE on any measures (trail making, color word interference, verbal fluency and switching).

We found that a sizable number of PNES and TLE patients exhibited weaknesses on tests of executive function. Continued assessments of this cognitive area within these two groups are warranted. Future research directions include identifying contributory factors in deficient executive skills of these two patient groups.