Authors :
Presenting Author: R. Faught, MD – Emory Unversity
Rashid Harris, BS – Emory University
Kyle Mathews, BS – Emory University
Yvan Bamps, MS – Emory University
Rationale:
Rationale: Patients who receive a diagnosis of both epilepsy and PNEE constitute a therapeutic problem. It is important to know the pitfalls in accepting this dual diagnosis as fact; especially the accuracy of diagnoses listed in electronic medical records..Methods:
Methods: We reviewed 536 medical records of patients discharged from the Emory University blood biomarkers in PNES vs. epilepsy. We excluded patients who had no seizures in the EMU, had a history of brain surgery, who had systemic neurological or inflammatory disease, or who had developmental and epileptic encephalopathies, leaving 325 patients who had relatively normal neurological histories except for the ictal events. Among these, 146 had no seizures in the EMU (45%), 102 had epileptic seizures (32%), 51 had PNEE (16%), and 26 (8%) had diagnoses of both epilepsy and PNEE based on their discharge diagnoses or electronic medical record (EPIC) problem lists . Among these, we identified 26 patients who had received dual diagnoses of PNES and epilepsy. Current and available past medical records were reviewed, as well as the EEG/videomonitoring data for them Hospital Epilepsy Monitoring Unit (EMU) from January 2024 to May 2025, as part of a study of.Seven patients had verified PNEE and epileptic seizures on EEG/videomonitoring, Results:
Seven patients had verified PNEE and epileptic seizures on EEG/videomonitoring, fulfilling ILAE criteria for documented dual diagnosis, Seven patients had verified PNEE but an epileptiform interictal EEG, 5 had episodes classified as PNEE but which reasonably could have been focal aware seizures with no EEG change, 5 had a remote epilepsy diagnosis carried forward but with no current or recent evidence for epilepsy, 1 had a diagnosis of PNEE carried forward from childhood with no current or recent evidence for PNEE, and 1 had documented PNES but focal temporal slowing on an EEG. Conclusions:
Conclusions: It is imperative to be certain about dual diagnoses of PNEE and epilepsy to guide appropriate therapy. The reported incidence of this combination has varied; our data suggest that it is uncommon. Electronic medical records may perpetuate diagnoses which are historical conjectures but are not supported by contemporaneous data. Discharge diagnostic codes and problem lists cannot be trusted; it is necessary for clinicians to review the actual medical records, EEGs, and video records before accepting this dual diagnosis.
Funding: Cognizance Inc.