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Seizure metaphors differ in patients’ accounts of epileptic and psychogenic nonepileptic seizures
Author(s) -
Plug Leendert,
Sharrack Basil,
Reuber Markus
Publication year - 2009
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/j.1528-1167.2008.01798.x
Subject(s) - psychogenic disease , epilepsy , psychology , metaphor , electroencephalography , conceptualization , logistic regression , psychiatry , clinical psychology , medicine , artificial intelligence , linguistics , philosophy , computer science
Summary Purpose: To increase understanding of the subjective symptomatology of seizure experiences and improve differential diagnosis by studying the seizure metaphors used by patients with (psychogenic) nonepileptic seizures (NES) and epilepsy. Methods: Twenty‐one unselected patients taking part in this study were admitted for 48 h of video‐EEG (electroenceophalography) observation because of uncertainty about the diagnosis. Eight were proven to have epilepsy, 13 to have psychogenic nonepileptic seizures (PNES). During their admission, patients were interviewed by a neurologist. A linguist blinded to the medical diagnosis identified and categorized all seizure metaphors in verbatim transcripts. Between‐group comparisons and logistic regression analysis were carried out. Results: Of 382 metaphors identified, 80.8% conceptualized seizures as an agent/force, event/situation, or space/place. Most patients used metaphors from all categories, but patients with epilepsy and PNES showed preferences for different metaphoric concepts (differences p = 0.009 to p = 0.039). Patients with epilepsy preferred metaphors depicting the seizure as an agent/force or event/situation. PNES patients more often used metaphors of space/place. Logistic regression analyses predicted the diagnosis of PNES or epilepsy correctly in 85.7% of cases (based on different metaphor types in the each category) or 81.0% (based on all metaphor tokens). Discussion: Patients with epilepsy and PNES have different preferences in the metaphoric conceptualization of their seizures. Epileptic seizures are described as a more external, self‐directed entity than PNES, which are depicted as a state or place patients go through. The differentiating value of metaphoric conceptualizations suggests that metaphor preference could form the basis of future diagnostic questionnaires or other diagnostic tools.