Abstracts

Rationale: Common morbidities shared by veterans of OEF/OIF including traumatic brain injury, posttraumatic stress disorder (PTSD), and posttraumatic epilepsy, can each contribute to neurobehavioral paroxysms. Our study aimed to share the results of our video-EEG (VEEG) monitoring data for veterans of OEF/OIF. We also examined whether any morbidity/risk factor may be associated with particular diagnosis(es) from VEEG monitoring.Methods: We retrospectively reviewed the medical records of patients admitted for VEEG monitoring at the Michael E. DeBakey VA Medical Center from January 2008 to May 2013. We identified a total of 78 OEF/OIF veterans admitted during this period. We excluded 14 patients who did not experience their typical habitual event of interest, which rendered them non-diagnostic. We also excluded 2 subjects who had mixed disorders of both epilepsy and psychogenic nonepileptic seizures (PNES). The remaining 63 subjects had VEEG confirmed diagnosis of PNES (n=46), epileptic seizures (n=16) and physiologic non-epileptic seizures (n=1). We further investigated the positive predictive value, sensitivity and specificity of the following risk factors: psychiatrist confirmed PTSD, mild TBI (mTBI) acquired prior to the onset of the patient s habitual paroxysms, or the combination of both in predicting the diagnosis of PNES.Results: The breakdown of VEEG confirmed diagnoses in the OEF/OIF subjects are summarized in Table 1. Among patients with a definitive diagnosis of PNES, 63% of the subjects had PTSD alone, 50% had mTBI alone, and 41.3% had a combination of both PTSD and mTBI. Among all patients with PTSD who received definitive VEEG diagnoses, 90.6% had PNES. The sensitivity of PTSD in identifying patients with PNES was 63%, while the specificity was 81.3 %. Among all patients with mTBI who received definitive VEEG diagnoses, 85.2% had PNES. The sensitivity of mild TBI in identifying patients with PNES was 50.0%, while the specificity was 75%. Among all patients with both mTBI and PTSD who received definitive VEEG diagnoses, 90.5% had PNES. The sensitivity of having the combination of mTBI and PTSD in identifying patients with PNES was 41.3%, while the specificity was 87.5%.Conclusions: This study uncovered a comparatively higher prevalence for PNES among OEF/OIF veterans who completed VEEG monitoring. The presence of mTBI and PTSD, which were common morbidities in this population, appear to be independently predictive of subsequent VEEG confirmation of PNES.