Abstracts

Rationale: Inpatient video-EEG monitoring is often used in the diagnostic evaluation of patients with paroxysmal events.  A proportion of these cases are ultimately diagnosed with psychogenic nonepileptic seizures (PNES), while some cases remained undiagnosed.  The treatment of PNES, in particular, can be difficult due to limited access to outpatient therapy.  The goal of this study was to analyze long-term outcomes of patients diagnosed with PNES compared to those diagnosed with epileptic seizures (ES), and to identify gaps in care.  Methods: This retrospective study included patients >18 years of age who were discharged from the Epilepsy Monitoring Unit (EMU) between 1/1/2016 and 1/31/2016.  Data was obtained through manual chart review.  Patients admitted for invasive video-EEG monitoring were excluded.  Purpose of admission (diagnosis, pre-surgical evaluation, or urgent admission for treatment of acute seizures), discharge diagnosis (ES, PNES, both ES and PNES, physiologic non-epileptic events, or inconclusive), completion of follow-up plan, and unplanned seizure-related emergency department (ED) visits and hospital admissions were recorded and analyzed.  Results: 50 patients were identified (median age 34 years, range 19-74). Median length of stay was 4 days (range 1-11).  The most common reason for admission was to diagnose paroxysmal events (58%); 22% of patients were admitted for urgent treatment, and 20% were admitted for pre-surgical evaluation and/or ictal SPECT.  Typical events were recorded in 78% of patients.  Overall, 42% of patients were diagnosed with ES (N=21), 36% with PNES (N=18), 2% with both ES and PNES (N=1), and 2% with physiologic non-epileptic events (N=1). 18% of evaluations (N=9) were inconclusive.  The follow-up plan was completed in 76% of patients (61% of PNES patients vs. 95% of ES patients).  The most common follow-up plan in PNES patients was outpatient psychotherapy, and appointments with a clinical psychologist were a median of 21 days post EMU discharge.  20% of patients had an unplanned seizure-related ED visit or hospital admission, 24% (5/21) of those with ES and 17% (3/18) of those with PNES.  Of the 3 patients with PNES, 2 did not follow-up with outpatient psychotherapy and the third did not accept the diagnosis of PNES. Of the 5 patients with ES, 2 patients had breakthrough seizures related to antiepileptic drugs (missed doses or dose adjustment) and 2 patients were sent to the ED unnecessarily after typical brief seizures without injury.  Median duration of follow-up was 365 days, but given the retrospective data collection, the extent and quality of follow-up data was highly variable.  Conclusions: One year following EMU evaluation, at least 20% of patients had at least one seizure-related ED visit or hospitalization. While PNES was a common discharge diagnosis after inpatient video-EEG monitoring, only 61% of patients returned for follow-up, compared to 95% of patients with ES.  Efforts should focus on identifying and addressing barriers to follow-up in patients with PNES. Funding: No funding was received.