Abstracts

Rationale: Cyprus is an island of less than one million inhabitants with relatively high educational and living standards. Largely due to the small size of the community, psychiatric disease carries a significant stigma and is underreported by patients. As a result, little is known both about the characteristics of patients with PNES, as well as the attitudes of the medical profession towards these patients in terms of management. This study is a first attempt to epidemiologically characterize a cohort of PNES patients and compare them with a cohort of epilepsy patients. Methods: The medical charts of patients diagnosed with PNES by video-EEG at the Cyprus Institute of Neurology and Genetics between 2001 and 2008 were retrospectively assessed. A total number of twenty nine patients were identified and these were matched for age and sex with a group of patients diagnosed with epilepsy by video-EEG at the same center. A statistical comparison of demographic parameters, comorbidities, frequency of events, number of anti-epileptic drugs (AEDs) used prior to, and after the diagnosis was performed between the two groups. Results: With regards to the demographic parameters, the only statistical significance was a younger age of onset in the group of patients with true epilepsy. There was no significant difference in other demographic variables such as marital status, level of education, place of residence (rural or urban) or the domestic situation. Overall, the patients with PNES had more frequent seizures compared to the epilepsy group. There was no significant difference in substance abuse between the groups, although this was likely underreported by the patients of both groups. After video-EEG, there was no significant difference as to whether the patients from either group left the center with a prescription of AEDs. However, overall, the epilepsy group was prescribed a significantly higher number of AEDs than the PNES group. Conclusions: The above findings are, generally, in co-cordance with the international published literature on PNES. The lack of significant difference in most demographic variables between the two groups, may be a reflection of the overall high socioeconomic levels in Cyprus, implying pre-existing high levels of education, high rates of marriage and high percentage of urbanization in both groups. The fact that most patients left the center with an AED prescription regardless of either diagnosis, may reflect the difficulty that the medical professionals have in Cyprus conveying a psychiatric diagnosis to the patient. However, the fact that the PNES group received overall less AEDs may be considered as a step in the right management direction. The identification of the above parameters in this study will serve to increase the understanding of the medical community on the island about PNES and raise the public awareness about the condition in an attempt to decrease the stigma of psychiatric disease in the society.