Abstracts

Rationale: Most epilepsy fellowship training programs in the country are structured to teach about the diagnosis, evaluation, and treatment of epileptic seizures (ES). However, epilepsy fellows frequently encounter patients with psychogenic non-epileptic seizures (PNES). The incidence of PNES is probably significantly higher than most clinicians realize and approximated to be 5% of the incidence of epilepsy. Previous studies have suggested that the incidence of PNES is 5-20% in an outpatient epilepsy population, and an incidence of up to 45% for inpatients studied at epilepsy monitoring centers. Therefore, education on PNES should be an important part of clinical epilepsy training. We reviewed our epilepsy monitoring database in order to determine what percent of patients presenting to our Epilepsy Monitoring Unit (EMU) were ultimately diagnosed with PNES during their stay, as encountered by an epilepsy fellow during the first year of training. Methods: We retrospectively reviewed the medical records for all patients admitted to our EMU for scalp-electrode video-EEG monitoring from 6/17/2009 to 6/10/2010 at the Barrow Neurological Institute in order to identify the prevalence of different seizure types. Patients were categorized into four main groups based on their diagnosis according to their ictal and interictal EEG findings, event semiology, and imaging studies: generalized seizures, partial seizures, psychogenic non-epileptic seizures (PNES), or other paroxysmal physiological disorders (i.e. syncope). Results: A total of 293 patients underwent continuous video-EEG monitoring with scalp electrodes between 6/17/2009 - 6/10/2010 and were evaluated by a single fellow. Of those patients, 27 (9.2%) had generalized onset seizures, 79 (27%) had partial onset seizures, and 93 (31.7%) had PNES. In addition, 12 (4.1%) had both true ES (generalized or partial onset) and PNES during the monitoring. Of the remaining patients, 10 patients had no events but interictal findings consistent with ES (generalized onset or partial onset seizures), 6 had probable simple-partial seizures without EEG changes, 3 had an undetermined seizure type, and 20 (6.8%) patients had other paroxysmal physiological events (7 cardiogenic, 5 panic attacks, 4 parasomnias, and 4 had other causes). 43 patients (14.7%) had no events and no interictal findings. Overall, we identified a total of 105 patients (35.8%) with PNES (with or without concurrent ES), compared with 125 patients (42.7%) with epilepsy alone based on ictal and interictal findings. Conclusions: Considering the fact that PNES patients accounted for more than one third of the EMU patients encountered by our epilepsy fellow during a one year period of time, education toward the diagnosis and treatment of PNES should be an essential component of epilepsy fellowship training programs, which may lead to earlier diagnosis and more effective treatment for patients with psychogenic non epileptic seizures.