Abstracts

This is a Late Breaking abstract

Rationale: Optimizing best treatment practices to maximize outcomes of individuals in rural communities living with PNES challenges effective implementation at well-established epilepsy centers. Targeted psychotherapy delivered through specialty centers can lead to reductions in emergency department utilization as well as improved quality of life. Team-based multidisciplinary approaches are increasingly being utilized to deliver care to patients with complex medical and psychological issues that overlap various subspecialties. As a rural population health focused system, our Comprehensive Epilepsy Center adapted a holistic care hybrid model leveraging internal resources in tandem with community-based behavioral health resources. This initiative includes tools to assess the baseline performance metrics of such a model comparing the longitudinal outcomes related to the care of these patients.

Methods: Our model includes patients evaluated at our center diagnosed with PNES via continuous video electroencephalography (cvEEG) and referred at the time of diagnosis in the Epilepsy Monitoring Unit (EMU) or through clinic referrals. Once the diagnosis is established, a proposed hybrid clinical model with two treatment pathways is engaged. The internal “health system” pathway mobilizes an institutional multidisciplinary team consisting of a neurologist, psychiatrist, and social worker certified in cognitive behavioral therapy (CBT) to evaluate each patient in a clinic workflow. The external “community mental health” pathway includes an asynchronous collaborative process between our health system with similarly trained personnel at a local community-based behavioral health agency (Coleman Health Services) both located in the same county. Team members in both pathways are trained in the delivery of individual CBT using a well-established program. Our workflow is designed to track psychometric measurements, functional assessments (NDDI-E, GAD-7, QOLI, etc.), seizure logs gathered at clinic visits, and key outcomes to evaluate the efficacy of this novel design.

Results: Behavioral health resources available at the community-based behavioral health hub were successfully matched with those provided internally at the medical center. A collaborative workflow was approved by the institution. The dominant admissions diagnosis for EMU monitoring was PNES. Elevated NDDI-E and GAD-7 measures are consistent with diagnosed major and sub-syndromic mood disorders.

Conclusions: The hybrid model described overcomes barriers to effectively match PNES for coordinated behavioral health and epilepsy specialty care. Outcome data are needed to assess the effectiveness of our model. This study underscores a substantial need for multidisciplinary, comprehensive evaluations and treatments for patients living with PNES. Even with implementation of novel multidisciplinary clinic models to address this need, access to these resources remains difficult for patients who experience PNES with barriers to close follow up. An increased delay between time of referral and initial clinic evaluation for patients with PNES is correlated with greater risk of chronic psychiatric co-morbidities, refractory PNES, and loss to follow up.

Funding: None