Abstracts

Rationale: We all are aware that separating non epileptic seizure like events (NESLE) from epileptic events (EE) can be a diagnostic challenge. Video EEG (VEEG) is the gold standard for distinguishing NESLE from EE but the referral for VEEG may be delayed because of low index of suspicion for NESLE. At least one study suggested that a lengthy NESLE screening instrument could assist in earlier identification of patients with NESLE and facilitate timely referral for video EEG but this measure provided limited useful clinical information. Various studies, including one completed at our institution, have suggested that NESLE patients are more likely to report specific risk factors than EE patients. We hope to identify the patients responses, on a questionnaire developed for clinical use and completed prior to VEEG, that are most predictive of NESLE during VEEG. The results of this study will be used to modify and develop the simplest and most useful questionnaire for epilepsy clinic patients, which may help with earlier identification for patients at highest risk for having NESLE.Methods: In this prospective study all patients referred for video EEG were sent the questionnaire as part of standard patient care. Patients were asked to bring the completed forms with them when they presented for admission. The questionnaire included clinical variables reported in the literature as associated with NESLE or EE. Informed consent was obtained after the admission. Inclusion criteria included being able and willing to participate by completing the questionnaire and having only NESLE and no evidence of EEG abnormality or only EE during VEEG. Results: 92 patients were screened, of which 14 patients had an EE and 25 patients had a NESLE. Reported age at first seizure (p > 0.01), nocturnal seizures (p > 0.02), crying or becoming emotional during the seizure (p > 0.02), partial awareness during seizure (p > 0.05), never being aware during seizure (p > 0.05) and having relative with depression(p>0.02) were significantly different between groups. Surprisingly some of the clinical variables which are classically associated with NESLE were not significantly different between the two groups including reports of incontinence (p = 0.75), tongue biting (p = 0.26), ictal eye closure (p=0.95) and side to side head movement (p=0.43)Conclusions: Preliminary results obtained from a self-report questionnaire developed for clinical use and completed prior to VEEG shows promise as a simple and cost effective tool in earlier identification of patients at risk of NESLE. In addition, some clinical variables that have been suggested as useful in distinguishing between EE and NESLE did not differ based on patient self-report.