Abstracts

Rationale: Psychogenic non-epileptic seizures (PNES) are involuntary movements, sensations, or behaviors that are not as a result of an abnormal electrical cortical discharge. They are presumed to be of psychological origin. There is a tremendous cost and morbidity associated with PNES presentation in the Emergency Department (ED). Patients may undergo neuroimaging, blood tests, and receive antiepileptic medications. Thus, it is important to understand how these patients are managed in the acute setting, so that improvements in their care can be developed. Our previous questionnaire study (Hussain et al., AES, 2010) revealed that 20% of ERMDs had never heard of PNES, 70% had no formal training about PNES, 19% said they would order neuroimaging and 28% said they would give IV benzodiazepines as a treatment. In this study, we sought to compare what they said they would do vs. what actually occurred.Methods: Patients with confirmed PNES were identified from the Beth Israel Epilepsy Monitoring Unit (EMU) over the past 48 months. 15/39 of these patients were seen in the ED. The presentation and the management of these patients were analyzed descriptively. IRB approval was obtained for both the EMU and the ED data collection. Results: 15/39 patients in the EMU with the diagnosis of PNES presented to the ED. 68% of the patients were females, and the age range was 18-65 years old. The chief complaint was seizure-like activity. 60% of the time the activity ( tonic-clonic ) was witnessed (clinic, ED, and ambulance). None of the patients reported incontinence or other autonomic symptoms. 20% of the patients reported aura with a headache. Glucose was elevated in 13% of the patients. Key findings included: Head CT was ordered in 70% of these patients, basic metabolic panel and CBC were obtained in 80% of the patients. The leading ED discharge diagnosis for these patients was epileptic seizure (73%) vs. PNES (13%) and the rest were others (e.g. anemia, stroke).Conclusions: Significant diagnostic testing was performed in PNES patients, some of which resulted in discomfort to patients. Sometimes this occurred even when previous chart data indicating a previous diagnosis of PNES were available. In general, ED MDs rarely considered PNES as a likely diagnosis in a majority of these patients. Interestingly, for several measures, there was a discrepancy between what they said they would do and what was actually done. There is a need to improve awareness and education about PNES.