Abstracts

Rationale: Psychogenic non-epileptic seizures (PNES) are commonly misdiagnosed with epileptic seizures. Approximately 20% of patients who were first suspected of having epilepsy were confirmed to have PNES instead (Benbadis and Heriaud, 2013). This is due to the similarities in physical manifestations that make PNES hardly distinguishable from epilepsy (Patidar, et. al., 2013). Studies have suggested a number of biopsychological characteristics which may improve the diagnosis of PNES (Elliot & Charyton 2014). The objective of our study is to detail the biopsychosocial characteristics of a group of patients with PNES from Hawaii, which is known for its unique ethno-cultural and racial diversity. Methods: Patients with PNES were identified from an initial cohort of 139 patients that underwent video electroencephalography (vEEG) at the Comprehensive Epilepsy Center, Hawaii Pacific Neurosciences, from 2014 to 2018. The patients’ demographics were recorded, and biopsychosocial factors, such as somatic symptoms, traumatic injury, tobacco use, marijuana use, drug abuse, family history of psychiatric disorders, family history of PNES or epilepsy, traumatic history, personality disorder, anxiety, depression, and PTSD, were collected for analysis of predictors of PNES (Asadi-Pooya, et al. 2016). Cross-group comparisons between patients with PNES, patients with epilepsy, and patients with other diagnoses were performed using descriptive statistics and the Fisher exact test. Results: Using vEEG monitoring and clinical characteristics, 51 patients were identified to have PNES. Of the non-PNES patients, 47 had epilepsy, and 41 had other non-PNES non-epilepsy diagnosis such as cardiovascular syncope or complex migraine. Between patients with PNES and patients with epilepsy, anxiety (p=0.0004) and traumatic history (sexual, physical, or psychological abuse) (p=0.0129) were found to be significant; while a trend was observed with patients with PNES experiencing more PTSD. In comparison to patients with other diagnosis, anxiety again was determined to be significant (p=0.0036) as well as PTSD (p=0.0396); while a trend was observed in traumatic history. Other biopsychosocial factors, such as somatic symptoms, drug use, family history of psychiatric disorder, family history of PNES, and personality disorder were not found to be significant. Conclusions: Predictor patterns for Hawaii’s PNES population are aligned with previously studied PNES populations, despite differences in Hawaii’s unique ethno-cultural and racial mix. In concordance with previous literature, anxiety and PTSD were found to be significant factors. Additionally, our patients with PNES also had more traumatic history, which may play a role in the somatization of PNES. These factors will assist our physicians in making a better prediction in the diagnosis of PNES. Funding: No funding