Abstracts

Rationale:
Psychogenic non epileptic events (PNEE) are paroxysmal events that may involve altered subjective experience and change in motor activity with a psychological cause. We aim to describe a population of patients with PNEE and identify factors predictive of 12-month outcomes in a prospective observational study.
Method:
Nationwide Children’s Hospital has a multidisciplinary PNEE clinic. A nurse coordinates care and conducts follow-up phone calls at one-, three-, and 12-months following the appointment to gather information to be tracked over time.  Outcomes data was compiled from patients who were referred to PNEE clinic between January 2018 and March 2019 and responded to follow-up calls. Descriptive statistics were used to describe demographics and outcomes. Event outcomes were compared based on timing (early compared to late) of diagnosis acceptance and linkage to behavioral health using paired sample t tests. The Phi correlation coefficient was used to compare capturing events on EEG with acceptance and event-freedom at 12-months. Odds ratios were calculated with 95% confidence intervals.
Results:
Of the 122 patients referred to PNEE clinic, 76% were seen in clinic and 61% answered 12-month follow-up calls. Complete remission was achieved by 45% at three-months but decreased to 28% at 12-months. Combined PNEE remission and improvement is 73% at one-month, increased to 86% at three-months, and reached 88% at 12-months. Patients and families who accepted the diagnosis at one-month were twice as likely to achieve remission or improvement at 12-months (t(56)=-7.099, p=0.000; OR=2.2, p=0.18). Likewise, those who were linked with counseling at one-month were 3.5 times more likely to achieve remission or improvement at 12-months (t(56)=-5.933, p=0.000; OR=3.5, p=.06). Less than half (44%) of patients reached at 12-months had their events documented on video-electroencephalogram (EEG) at the time of diagnosis, however those that did were 45 times more likely to be accepting of the diagnosis at 12-months (Phi coefficient=.528, p=.000; OR=45, p=0.01) and 113 times more likely to be event free at 12-months (Phi coefficient=.707, p=.000; OR=113, p=0.001).
Conclusion:
Patients diagnosed with PNEE have increasing acceptance and counseling over time following diagnosis. Remission rates rise within the first three months, and fall by 12 months; however, improvement in events is better sustained over time. Connection to counseling and early acceptance of diagnosis by one-month were associated with increased remission and improvement rates at 12-months. Capturing events on video-EEG was strongly correlated with increased acceptance and event-freedom at 12-months. Focus should be placed on documentation of events on EEG when possible, presenting the diagnosis in a manner that increases early acceptance, and followed by strong encouragement to connect with counseling quickly to achieve a goal of increasing 12-month PNEE remission rates. More investigation is needed to elucidate potential causes for relapse in PNEE over time.
Funding:
:There was no funding support for this work.