Neurological Sciences

, Volume 40, Issue 3, pp 571–576 | Cite as

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

  • Jennifer M. Stinson
  • Jessica E. Chang
  • Jordan S. Robinson
  • Jesse S. Passler
  • Robert L. CollinsEmail author
Original Article


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.


Epilepsy Patient Competency Rating Scale Psychogenic non-epileptic events Seizure disorders 



This material is the result of work supported with resources and the use of facilities at Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX.

Compliance with ethical standards

The Institutional Review Board of the Michael E. DeBakey VA Medical Center (MEDVAMC) and Baylor College of Medicine approved this research and we have fully complied with the APA ethical standards throughout this research project.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Barskova T, Wilz G (2006) Psychosocial functioning after stroke: psychometric properties of the patient competency rating scale. Brain Inj 20(13–14):1431–1437CrossRefPubMedGoogle Scholar
  2. 2.
    Baslet G, Prensky E (2013) Initial treatment retention in psychogenic non-epileptic seizures. J Neuropsychiatr Clin Neurosci 25(1):63–67. CrossRefGoogle Scholar
  3. 3.
    Benbadis S (2009) The differential diagnosis of epilepsy: a critical review. Epilepsy Behav 15(1):15–21. CrossRefPubMedGoogle Scholar
  4. 4.
    Benge JF, Wisdom NM, Collins RL, Franks R, Lemaire A, Chen DK (2012) Diagnostic utility of the structured inventory of malingered symptomatology for identifying psychogenic non-epileptic events. Epilepsy Behav 24(4):439–444. CrossRefPubMedGoogle Scholar
  5. 5.
    Borgaro SR, Prigatano GP (2003) Modification of the Patient Competency Rating Scale for use on an acute neurorehabilitation unit: the PCRS-NR. Brain Inj 17(10):847–853CrossRefPubMedGoogle Scholar
  6. 6.
    Hall-Patch L, Brown R, House A, Howlett S, Kemp S, Lawton G, collaborators, N (2010) Acceptability and effectiveness of a strategy for the communication of the diagnosis of psychogenic nonepileptic seizures. Epilepsia 51(1):70–78. CrossRefPubMedGoogle Scholar
  7. 7.
    Krumholz A, Hopp J (2006) Psychogenic (nonepileptic) seizures. Semin Neurol 26(3):341–350. CrossRefPubMedGoogle Scholar
  8. 8.
    Lawton G, Mayor RJ, Howlett S, Reuber M (2009) Psychogenic nonepileptic seizures and health-related quality of life: the relationship with psychological distress and other physical symptoms. Epilepsy Behav 14(1):167–171. CrossRefPubMedGoogle Scholar
  9. 9.
    Lee GP (2010) Neuropsychology of epilepsy and epilepsy surgery. Oxford University Press, OxfordGoogle Scholar
  10. 10.
    Leidy NK, Elixhauser A, Vickrey B, Means E, Willian MK (1999) Seizure frequency and the health-related quality of life of adults with epilepsy. Neurology 53(1):162–166CrossRefPubMedGoogle Scholar
  11. 11.
    Prigatano GP, Altman IM, O'brien KP (1990) Behavioral limitations that traumatic-brain-injured patients tend to underestimate. Clin Neuropsychol 4(2):163–176CrossRefGoogle Scholar
  12. 12.
    Reuber M, Elger CE (2003) Psychogenic nonepileptic seizures: review and update. Epilepsy Behav 4(3):205–216CrossRefPubMedGoogle Scholar
  13. 13.
    Sirven JI, Glosser DS (1998) Psychogenic nonepileptic seizures: theoretic and clinical considerations. Neuropsychiatry Neuropsychol Behav Neurol 11(4):225–235PubMedGoogle Scholar
  14. 14.
    Szaflarski JP, Hughes C, Szaflarski M, Ficker DM, Cahill WT, Li M, Privitera MD (2003) Quality of life in psychogenic nonepileptic seizures. Epilepsia 44(2):236–242CrossRefPubMedGoogle Scholar
  15. 15.
    Wyllie E, Cascino GD, Gidal BE, Goodkin HP (2012) Wyllie’s treatment of epilepsy: principles and practice. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar

Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.Department of NeurologyBaylor College of MedicineHoustonUSA
  2. 2.San Francisco VA Health Care SystemSan FranciscoUSA
  3. 3.VA Puget Sound Health Care SystemTacomaUSA
  4. 4.Neurology Care Line (127), Michael E. DeBakey VA Medical Center, Department of NeurologyBaylor College of MedicineHoustonUSA

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