Utilization of the Patient Competency Rating Scale in an epileptic and non-epileptic veteran population

Differentiating between epilepsy and psychogenic non-epileptic events (PNEE) can be difficult given similar presentations. PNEE is often misdiagnosed, resulting in unwarranted treatment with anti-epileptic drugs (AED). While the gold standard for differentiating PNEE from epilepsy is video EEG (VEGG) monitoring, self-reported symptomology has also been shown to discriminate between epilepsy and PNEE with high accuracy, particularly in cases where VEEG is difficult to obtain or when there are no observed events during extended monitoring. The Patient Competency Rating Scale (PCRS) was developed to measure the extent to which individuals are able to function in four domains: activities of daily living, emotional, interpersonal, and cognitive competency. Factor analyses validated the underlying factor structure of the PCRS in this seizure disorder sample. Follow-up MANOVA revealed group differences such that those diagnosed with PNEE reported less competence in all areas of functioning as compared to those diagnosed with epilepsy, with the largest difference being emotional competency. Secondary factor analyses were conducted for each diagnostic category. Two items related strongly to emotional competency loaded equally across the factors for those diagnosed with PNEE, indicating that emotional control is highly correlated with all areas of perceived competence for those with PNEE in this sample and may be considered as an intervention target. This was the first study to validate the use of the PCRS for a seizure disorder sample and to examine group differences in self-reported competency between those diagnosed with epilepsy and PNEE.