A Comparison Among the Prevalence of Alexithymia in Patients With Psychogenic Nonepileptic Seizures, Epilepsy, and the Healthy Population: A Systematic Review of the Literature.

BACKGROUND: The construct of alexithymia includes a deficit in identifying and describing feelings. It has been proposed that alexithymia plays a role in the etiology of PNES but patients with epilepsy have also scored high on measures of alexithymia.

OBJECTIVES: To determine the prevalence of alexithymia in patients with psychogenic nonepileptic seizures (PNES) and to compare it with patients with epilepsy and healthy controls.

METHODS: We performed a systematic review of the literature based on Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. We searched MEDLINE, EMBASE, and PsycINFO databases. Studies using the Toronto Alexithymia Scale (TAS-20) to measure alexithymia in adult patients with PNES, were compared with a control group (epilepsy or healthy controls).

RESULTS: Six studies were included in this review. A total of 364 patients with PNES, 234 patients with epilepsy, and 129 healthy controls participated in these studies. Prevalence of alexithymia in PNES (30-90%) was higher than those in the healthy population (5-14%), but not significantly different from those with epilepsy (26-76%). In 3 studies the results were controlled for depression and anxiety. One study found a small correlation between alexithymia and a history of abuse (r = 0.15). Alexithymia appears to mediate perceived quality of life.

CONCLUSIONS: This review suggests that the prevalence of alexithymia in patients with PNES is similar to that in patients with epilepsy, both significantly higher than those in the healthy population. This finding can point to shared psychiatric and psychosocial factors between these patients. Therapies aimed at increasing emotional awareness may be important in improving quality of life.