Abstracts

Rationale: Psychogenic Non-Epileptic Spells (PNES) are paroxysmal events that resemble epileptic seizures but are not associated with abnormal electrical discharges on electroencephalogram (EEG). PNES is the most common mimic of epileptic seizures and is ultimately diagnosed in up to 40% of people referred to tertiary epilepsy centers for refractory seizures. Misdiagnosis of PNES as epilepsy is associated with a worse prognosis and a poorer quality of life. Knowledge of clinical associations allows providers to risk stratify people with undifferentiated spells by history alone, allowing for more timely diagnoses and earlier treatment to support improved outcomes. Risk factors already well described for PNES include history of trauma, psychiatric co-morbidities, and chronic pain, among others.

There is no data regarding the incidence of PNES in sexual and gender minority (SGM) populations. The SGM population faces significant emotional stressors as a minority group. Given the implicit stress associated with minority status, we hypothesize that there will be a higher incidence of PNES in the SGM population. In this study, the incidence of PNES was estimated among individuals admitted to a hospital epilepsy monitoring unit (EMU).


Methods: A retrospective chart review was conducted on people admitted to a single center’s EMU for video EEG monitoring to facilitate definitive diagnosis of paroxysmal events over a 13-year period. Inclusion criteria included age greater than 8 years at admission and documented values for sex assigned at birth, gender identity, and sexual orientation. Non-diagnostic admissions were excluded. Diagnoses were obtained from review of the discharge summaries and EEG procedure notes; subjects were considered to have PNES if they were diagnosed with PNES alone or with overlap PNES and epilepsy. Subjects were classified as SGM if their documented sexual orientation was not “Straight” and/or their birth sex did not match their gender identity.


Results: In total, 170 subjects were identified for review with a mean age of 36.7 (range 9-81). There was a slightly higher percentage of female identifying individuals (56%) with approximately 1% identifying as “genderqueer” and the remaining group male identifying (42%). Approximately 15% (n=25) met criteria for SGM. A third of the total population was diagnosed with PNES (n=57). Of SGM individuals, 11/25 (44%) were diagnosed with PNES. This 44%, while higher than the incidence of PNES among non-SGM individuals (32%), did not reach statistical significance (p=0.22).


Conclusions: The higher proportion of PNES diagnoses among SGM population when compared to their non-SGM counterparts, while not statistically significant, does demonstrate a trend towards significance that merits evaluation in larger populations. This possible association may be related to increased victimization rates previously identified in these groups or other factors that could not be identified in this initial exploratory study. Further research in this area would help to improve care of SGM patients with both epilepsy and functional seizures.


Funding: None