Abstracts

Rationale: Non-epileptic seizures (NES) are commonly seen in both outpatient epilepsy clinics where an estimated 25% of all new patient visits have this diagnosis, and in electrodiagnostic monitoring units (EMU) where the percentage of people admitted for seizure characterization with NES is 30 - 40% of admissions. An estimate of the delay to diagnosis of NES is 6 years. From onset to diagnosis, patients with NES are treated as though they have epileptic seizures (ES). This accounts for years of treatment with anti-seizure medications, neurology visits, brain imaging studies, electroencephalogram and visits to the emergency department (ED) prior to diagnosis in an EMU of the NES condition. None of this costly care is directed at the actual problem which is thought to be underlying psychological stress. Pilot studies at our institution demonstrated a very high rate of ED use in the NES population compared to patients with ES. We sought to quantify healthcare utilization (HCU) and comorbid diagnoses in the NES population to identify key underlying comorbidities which may be a target for diverting care from the ED setting to more appropriate HCU. Methods: This is an investigator initiated, retrospective cohort study. IRB approval was obtained. A cross sectional analysis of patients with epilepsy, NES and combined ES and NES in the EMU from January 2013 - June 2016 was done. Exclusion criteria: patients without follow up, patients admitted for epilepsy surgery work-up, patients monitored outside the EMU and patients with a dual diagnosis of NES and ES were studied. Chart review by a trained research assistant and 2 epileptologists was done and validated. Queries to the electronic medical record yielded HCU for NES and ES patients. A relational data base compared HCU, diagnosis codes and comorbidities between groups. Results: Data collection is complete and preliminary results show of 618 charts reviewed, an N= 309 (50%) were diagnosed with ES and N=249 (40%) with NES. NES and ES yielded N=60 (9.7%) of the total number admitted for evaluation in the EMU. The average length of stay (LOS) in the EMU for these two groups is 2.82 days for the NES group vs. 4.39 days in the ES population. Emergency department (ED) utilization shows an average number of 8 visits (SD 17.33) for the NES population vs. 4.18 (SD 4.99) in the ES population. ED use per patient ranges from 0 to 116 visits in the NES group and from 0 - 31 in the ES population. This includes outliers in both groups. We are also analyzing utilization of imaging scans and outpatients visits in the two groups. NES patients had an average of 10.71 (SD 16.11) imaging studies vs. 8.02 (9.78) for ES patients. NES patients had an average of 17.41 (SD 16.11) outpatient visits vs. 16.21 (15.98) for ES patients. Data on comorbidities in both groups and ED diagnoses have been collected and await further analysis. Conclusions: Preliminary results show higher ED use in NES patients compared to ES in agreement with our pilot data. We found a shorter LOS in the EMU for the NES population. We will determine if the shorter LOS is supplanted by the greater number of EMU visits. Projected cost savings, justify a treatment program targeted at the NES population. A preliminary analysis of diagnosis codes applied for radiology and outpatient care in both groups reveal much of the care is directed at epilepsy, which in the case of NES is inappropriate. LIkewise, preliminary review of associated diagnoses in outpatient care is showing a signal of greater comorbid gastrointestinal and pain complaints. Future projects will use this analysis to improve an NES treatment program with more targeted therapy for this population. Funding: n/a self funded.