Abstracts

Rationale: The relationship between psychiatric disease and non epileptic seizures has been studied since the days of Charcot. And since that time Professionals in Epilepsy Care are challenged with muddling through the complexities of psychopathology that afflict individuals with both Epileptic and Non Epileptic Seizures. Providers of epilepsy care are trained to be experts in recognizing stereotypical epileptic behaviors and EEG patterns with the ultimate goal of 'uncovering epilepsy or the lack of'. Experts may fill up an entire page describing brain wave patterns and accounts of epileptic behaviors and treatments. But we continue to struggle with diagnosing psychiatric illness and making assumptions about the seizure type. Providers can be confounded and mistakenly attribute a prominent psychiatric symptom to a Non epileptic etiology. This study was undertaken to help with our understanding of both epileptic and non epileptic seizure groups and their psychiatric counterparts with the goal of improving our care to both groups of Veterans in need. Methods: A retrospective chart review was conducted on all veterans admitted to the Durham VA Medical Center for Video EEG monitoring between January of 1998 and January of 2010. The electronic medical records of 128 patients were reviewed. 37 patients were diagnosed with epileptic seizures, 54 patients were diagnosed with non-epileptic seizures, 31 patients did not have an event during monitoring and 6 patients had both epileptic and non-epileptic seizures detected on Video-EEG. The epileptic seizure group (ES) was compared with the Non-epileptic seizure group(NES) for 1) total number of psychiatric disorders and 2) types of psychiatric disorder. Odds ratios with confidence intervals were used to determine if ES and NES groups had different outcomes for the above mentioned clinical features. Results: The odds of psychiatric disorders in NES group were 2.98 times the odds of psychiatric disorders in ES group (95% confidence interval (1.20 7.40). Among noticeable categories of psychiatric disorders the odds of depression in ES group were 6.10 times the odds of depression in NES group (95% confidence interval (2.10 17.76). Contrary to this NES group was more likely to have PTSD than ES group (OR=6.13, 95% confidence interval (1.30 28.84). Conclusions: This retrospective review did confirm that Veterans with non epileptic Seizures do have more psychiatric disorders in total than Veterans with epileptic seizures. PTSD is more common with NES and depression is more common with ES. These results do reinforce our belief that PTSD is a significant risk factor for NES more so than any other psychiatric disorder. It also suggests that a diagnosis of depression may be a more significant risk factor for epilepsy that for non epilepsy, which is a slight shift in thinking. Overall it points to the importance of making a correct psychiatric diagnosis early on in the presentation of seizure behaviors.