Abstracts

Rationale: The gold standard for identification of patients with psychogenic nonepileptic seizures (PNES) is video/eeg monitoring (VEEG). Other potentially useful adjuncts include history and prolactin levels. When confronted with a new patient with unexplained spells, the physician often relies on certain risk factors (e.g. physical or sexual abuse) to suggest the possibility of a PNES diagnosis. However, it would be useful to have other easily obtainable data at the time of the visit to support or refute one's suspicion of PNES. We decided to look at the patient's medication profile in detail, to determine whether there were features in the list that help distinguish between a diagnoses of PNES vs. epileptic seizure (ES). Methods: Consecutive cases of patients with PNES (n=17) and ES (n=16), confirmed by VEEG monitoring were retrospectively identified from the Epilepsy Monitoring Unit database. Patient charts were reviewed and analyzed for demographics, medication lists (past and present) and co-morbidities. Preliminary review suggested that benzodiazepines were used for anxiety, and not for seizure. Data were analyzed descriptively. IRB approval was obtained. Results: The mean age was: PNES: 38 (26-66), ES: 34 (24-66). M/F ratio: PNES: 4/13; ES:7/9. Duration of 'SZ' in years: PNES: 5; ES: 7. Total Rxs: PNES: 6.5; ES: 7.7. All patients were taking antiepileptic medications (AEDs), though the average number was slightly higher for ES (2.2) vs. PNES (1.6). More patients with PNES (35%) vs. ES (12.5%) were taking benzodiazepines. More patients with PNES (29.4%) than ES (18.8%) were taking antipsychotics. The same trend was true for antidepressants: PNES (35%) vs. ES (12.5%). Also, PNES (29.4%) vs. ES (18.8%) were more likely to be taking antihypertensives and antidiabetic agents (PNES: 11.7% vs. 0%). Asthma (PNES: 23.5% vs. ES: 6.3%) and pain (PNES:11.7% vs. ES:6.3%) medications were more common in PNES patients. GI meds were slightly more common in PNES (17.6%) vs. ES (12.5%). While homeopathic medications appeared infrequently in both groups, they were slightly more common in PNES (6%) vs. ES (0%). Vitamin use (ES: 81.3% vs. PNES: 29.4%) and thyroid medications (ES: 100% vs. PNES: 66%) were more common in ES. Conclusions: This study suggests that there are differences in the medication profile of patients with PNES vs. ES. While the total number of medications was slightly greater for ES patients, with several exceptions, PNES patients were taking medications for more co-morbidities. The greater number of medications in the ES group most likely reflected a greater number of AEDs. More PNES patients were taking various CNS psychiatric medications. They were also taking more asthma, pain antihypertenisives and antidiabetic agents. Limitations of the study include retrospective nature, small number of subjects, single center, and selection bias (referral for VEEG). Nonetheless, attention to a patient's medication list may provide an additional clue to help distinguish among patients with PNES vs. ES.