Abstracts

Rationale: Standard Medical Care (SMC) for psychogenic nonepileptic seizures (NES) was described in North America (NA). We sought to compare diagnostic and treatment practices in NA to Latin America (LA). Based on the prior NA survey, we hypothesized that a. NA uses more technology to diagnose, and therefore can explain the diagnosis with more assurance, thereby referring patients with NES off to mental health providers; and b. neurologists in LA, will follow and treat NES and comorbidities more often than NA neurologists. Methods: A survey on diagnosis and treatment practices for NES was administered to 117 practicing clinicians in LA. Results were compared to results from 317 NA clinicians. We used a significance level of alpha=0.005. Results: Hypotheses tested involved: 1. Diagnosis: NES diagnosis is made by inpatient video EEG/LTM in 88% of NA respondents, compared to 28% of LA respondents, p<0.0001. Less than half of LA respondents (47%) reported having vEEG available, compared to 95% of NA respondents, p<0.0001; however, when comparing the LA centers with access to any vEEG (including outpatient short term or ambulatory with video), there were no differences in the proportion using vEEG for NES diagnosis, p<0.0166. In line with the hypotheses, the diagnosis of NES is made by history and exam alone at twice the rate in LA (38%) than NA (16%), p<0.0001. 2. Disposition: Once the diagnosis of NES is made, 73% of NA respondents, compared to 85% of LA respondents refer for treatment by psychiatrist, p=0.0052; 39% of NA respondents, compared to 29% of LA respondents reported that neurologists continue to follow, p=0.0609. 3. Etiology: The etiology of NES is attributed to trauma/abuse in 43% of NA respondents, compared to 8% of LA respondents, p<0.0001. The highest frequency attributable cause of NES among LA respondents was anxiety, reported by 37% of respondents. 4. Treatment: Presumed treatments included relaying the diagnosis, psychotherapy, psychopharmacotherapy, AEDs, other and do not know . All categories were equivalent with similar percentages between NA and LA, except for psychopharmacotherapy. A higher proportion of LA respondents (64%) endorsed psychopharmacotherapy to be of benefit than NA respondents (32%), p<0.0001. 5. Medications: Just under half of LA and NA respondents prescribed psychotropics when a psychiatric comorbidity to NES was identified. LA respondents (49%) were no more likely to prescribe psychotropics than NA respondents (47%), p=0.7106. A higher proportion of NA respondents (83%) discontinued AEDs if lone NES was diagnosed than LA respondents (68%), p=0.0010.