Clinical Topics

Veterans With PNES Have Lower QoL vs. Other Seizures

by U.S. Medicine

June 26, 2019

PORTLAND, OR—Do seizure disorders affect veterans differently than patients who have never been in the U.S. military? And does the type of seizure matter?

A study published in Epilepsy & Behavior examined those issues.1 

VA researchers from Portland, OR; Madison, WI; and San Francisco pointed out that health-related quality of life is affected in civilians with epileptic seizures or psychogenic nonepileptic seizures, adding, “U.S. veterans are a distinct patient group with regard to gender, age and background.”

The study team looked at HRQoL in a veteran cohort, seeking to answer the following questions:

  • Is there a difference in HRQoL in veterans with ES vs. PNES?
  • What factors influence HRQoL in each group?
  • What factors influenced the difference between seizure groups?

To determine the answers, the researchers looked at consecutive veterans entering the epilepsy-monitoring units of three VA Epilepsy Centers of Excellence. Patients underwent continuous video-EEG monitoring, and health-related quality of life was measured with the Quality of Life in Epilepsy Inventory-31 (QOLIE-31).

Evaluations included the Structured Clinical Interview for Diagnostic and Statistical Manual-IV, the Post-traumatic Stress Disorder Checklist (PCL), the Beck Depression Inventory II and the Minnesota Multiphasic Personality Inventory-2 Restructured form. 

Results indicated that The median QOLIE-31 total score was 14 points lower in veterans with PNES vs. ES (p < 0.001; Cohen’s d = 0.73). “Within each seizure group, psychological factors accounted for ≥50% of the variance in QOLIE scores, while combined demographic, social and seizure-related factors accounted for 18% (group with ES) and 7% (PNES),” the researchers explained. “Psychological measures, particularly PCL and the BDI-II scores, accounted for all of the difference in QOLIE-31 total scores between Veterans with ES and those with PNES.”

The study authors concluded that health-related quality of life, as measured by the QOLIE-31, is worse in veterans with PNES as compared with those with ES. 

“Demographic, military, social and seizure-related factors have minimal influence on HRQoL. These results in U.S. veterans are similar to those found in civilians despite differences in patient age, gender, and background.”

Salinsky M, Rutecki P, Parko K, Goy E, Storzbach D, Markwardt S, Binder L, Joos S. Health-related quality of life in Veterans with epileptic and psychogenic nonepileptic seizures. Epilepsy Behav. 2019 Mar 17;94:72-77. doi:10.1016/j.yebeh.2019.02.010. [Epub ahead of print] PubMed PMID: 30893618.

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