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 Volume 63, Number 3, August 10, 2004
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NEUROLOGY 2004;63:516-519
© 2004 American Academy of Neurology

Ictal stuttering

A sign suggestive of psychogenic nonepileptic seizures

D. G. Vossler, MD, A. M. Haltiner, PhD, S. K. Schepp, MS, P. A. Friel, MSW, L. M. Caylor, MD, J. D. Morgan, MD and M. J. Doherty, MD

From the Epilepsy Center and Clinical Neurophysiology Laboratories (Drs. Vossler, Haltiner, Caylor, Morgan, and Doherty, and P.A. Friel), Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA; and Department of Neurology (Drs. Vossler and Doherty) and School of Medicine (S.K. Schepp and Dr. Doherty), University of Washington, Seattle.

Address correspondence and reprint requests to Dr. Vossler, Epilepsy Center, Swedish Neuroscience Institute, 801 Broadway #901, Seattle, WA 98122; e-mail: david.vossler{at}swedish.org

Objective: To determine if ictal stuttering (IS) is more common among patients with psychogenic nonepileptic seizures (PNES) than patients with epileptic seizures (ES).

Methods: The authors prospectively reviewed the medical records, EEG-video recordings, and Minnesota Multiphasic Personality Inventory-2 (MMPI-2) scores of consecutive adults of normal intelligence diagnosed with either PNES or ES.

Results: A total of 230 (117 PNES and 113 ES) patients were studied. PNES patients were older (p = 0.029), more likely to be female (p < 0.001), and had a shorter duration of seizure disorder (p < 0.001) than ES cases. Ten (8.5%) PNES subjects and no ES cases demonstrated IS. The proportion of patients with IS in these two groups was significantly different (p = 0.004). PNES patients with IS were of similar age as but had an even shorter (p = 0.010) duration of seizure disorder (mean = 3.0 years) than those without IS. Scores on the hypochondriasis, depression (D), and hysteria scales of the MMPI-2 were significantly higher among PNES subjects than in ES patients (p ≤ 0.002). However, seven PNES patients with IS had a lower mean score on the D scale than did 98 PNES cases without stuttering (p = 0.005). This produced a more sharply defined "conversion V" appearance on the MMPI-2 graph in the stutterers.

Conclusions: Ictal stuttering was present in 8.5% of 117 consecutive patients with psychogenic nonepileptic seizures, but was not observed in a consecutive series of 113 adults with epileptic seizures. Patients with psychogenic nonepileptic seizures with ictal stuttering had a shorter duration of seizure disorder and a more prominent conversion profile on the Minnesota Multiphasic Personality Inventory than either patients with psychogenic nonepileptic seizures without stuttering or subjects with epileptic seizures.

Received December 9, 2003. Accepted in final form March 29, 2004.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the August 10 issue to find the title link for this article.


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August 10 Highlights
Neurology 2004 63: 408-409. [Full Text] [PDF]





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