Neuropsychological characteristics of nonepileptic seizure semiological subgroups Stacy W. Hill a, ⁎, Shawn D. Gale a, b a Department of Clinical Neuropsychology, Barrow Neurological Institute, Phoenix, AZ, USA b Psychology Department, Brigham Young University, Provo, UT, USA abstract article info Article history: Received 8 April 2011 Revised 6 June 2011 Accepted 11 June 2011 Available online 22 July 2011 Keywords: Nonepileptic seizures Subgroups Neuropsychological Epilepsy Semiology The present study sought to identify neuropsychological characteristics of patients with nonepileptic seizures (NESs) based on seizure semiological subgroups and to make comparisons among NES subgroups and with patients with temporal lobe epilepsy (TLE). A total of 173 patients with NESs and 180 patients with TLE were included in this study. Statistical comparisons were made between a NES four-subgroup model, a NES two- subgroup model, and patients with TLE on neurocognitive measures. A trend toward declining performance was noted across the subjective, catatonic, minor motor, and major motor subgroups, respectively. The nonmotor subgroup showed stronger performance on verbal intelligence, naming, verbal learning, and verbal memory compared with the TLE group. The motor subgroup generally performed equivalently to the patients with TLE. Results indicate that patients with more dramatic seizure semiology appear to have lower neurocognitive functioning at a level comparable to that of patients with TLE. Patients with NESs with the least dramatic semiology appear to have fewer neurocognitive abnormalities. © 2011 Elsevier Inc. All rights reserved. 1. Introduction Patients with nonepileptic seizures (NESs) constitute a substantial portion of all patients seen in outpatient seizure clinics and those referred for epilepsy monitoring unit observation [1–3]. Although video-electroencephalography (VEEG) is the gold standard in diag- nosing NESs [4], neuropsychological examination is a common component of the evaluation process [5]. NESs are thought to have a psychiatric etiology; however, neurocognitive abnormalities have been found across a number of studies. Examination of various NES subgroups may provide clarification and further characterization of neurocognitive status among patients with NESs and between those with NESs and patients with temporal lobe epilepsy (TLE). Subgroups are relevant given that patients with NESs are heterogeneous with respect to Axis I and II psychopathology [3,6–9] as well as seizure semiology. Several researchers have categorized NES subgroups based on seizure semiology [10–14]. Griffith et al. [10] developed a classification model comprising four groups: subjective, catatonic, minor motor, and major motor (see Methods for details regarding subgroups). The four-subgroup model was a modification of the Selwa et al. [14] six-group model and showed better interrater reliability. Minnesota Multiphasic Personality Inventory-2 (MMPI-2) profiles indicated less severe psychopathology reported by patients with the catatonic subtype as compared with those with the minor or major motor subtype [10]. Neuropsychological variables showed a trend toward significance between catatonic and motor (minor and major motor) subgroups [15]. In both Griffith et al. studies [10,15] the sample size was small, which may have reduced the ability to identify actual between-subgroup differences. In addition, these studies did not compare NES subgroups with patients with epilepsy [10,15]. When NES subgroups have not been used, inconsistent results have been noted across studies comparing neurocognitive status between patients with NESs and those with TLE. The most common finding has been comparable neurocognitive functioning in patients with NESs and TLE that is lower than that observed in normative samples [13,16,17]. Some researchers have suggested that reduced effort/motivation or mood-related variables may, in part, account for reduced neurocognitive functioning in patients with NESs [18,19]. However, others have noted a similar level of reduced effort in patients with NESs and TLE [20,21]. Nevertheless, psychological factors have been conceptualized as the mechanism by which effort and neurocognitive performance become reduced [16,22,23]. Still, sample characteristics and the heterogeneous nature of patients with NESs may influence performance on neurocognitive measures and results across studies. The present study used a larger sample size than employed in previous studies [10,15] and sought to compare neuropsychological characteristics between NES semiological subgroups as defined by Griffith et al. [10]. In addition, a further simplification of the Griffith et al. [10] four-group model was evaluated and compared with patients with TLE. On the basis of previous studies, it was hypothesized that differences would be observed between NES subgroups, with declining performance across subjective, catatonic, minor motor, and major motor subgroups, respectively. It was also hypothesized Epilepsy & Behavior 22 (2011) 255–260 ⁎ Corresponding author at: Department of Clinical Neuropsychology, Barrow Neurological Institute, 222 West Thomas Road, Suite 315, Phoenix, AZ 85013, USA. E-mail address: Stacy.Hill@chw.edu (S.W. Hill). 1525-5050/$ – see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.yebeh.2011.06.011 Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh