Abstracts

Diagnosis of pseudoseizures (non-epileptic seizures) can be a challenge. Their management can be time-consuming, and large health-care costs are attributed to this condition. Accurate and early diagnosis is critical in order to implement appropriate treatment. The literature is not clear on the benefits of inpatient investigation of these patients, and what factors are associated with good outcomes. It was hypothesized that patients with good acceptance of the diagnosis of pseudoseizures, and who receive psychological treatment following discharge, would show evidence of more favourable outcomes. We report a long-term follow-up investigation of patients who, on the basis of inpatient epilepsy-unit monitoring, were diagnosed with pseudoseizures.
Fifty patients (33 females) having the inpatient-based diagnosis of non-epileptic seizures were administered a structured phone interview a mean of 4.9 years (minimum one year) following discharge. Data representing seizure characteristics, treatment modalities, and quality of life at the time of admission were compared (t-tests) with the same measures at follow-up. Multiple regression analysis were also performed, with initial acceptance of the diagnosis and receiving psychological treatment as predictors of follow-up.
Preliminary data analyses indicate that at the time of inpatient investigation, (a) mean number of AEDs was 2, (b) 40% were employed, 30 were receiving disability benefits, (c) 40% were driving, (d) most were married, and (e) the mean QOL rating was [quot]good[quot] (3 on 1-5 scale). Follow-up data (mean 4.9 years) indicated: (a) significant reduction in AEDs (mean [lt]1; [underline]p[/underline][lt].01) with the over half the sample medication-free, (b) approximately half endorsed initial acceptance/agreement with the diagnosis, (c) no changes in rates of driving and employment, (d) 78% sought psychological treatment, and 89% of those (35 of 39) found it helpful. Sixty-seven percent stated their inpatient investigation was helpful to them; reasons included clarifying their problem, providing helpful treatment, and reducing/discontinuing AEDs. Regression analyses indicated both initial acceptance of diagnosis and seeking psychological treatment were associated with improved QOL ratings and decreased AEDs.
The diagnosis of pseudoseizures is critical, the first step in leading to appropriate treatment. This study suggests the manner in which the diagnosis is communicated is critical, potentially influencing acceptance of the problem and setting the stage for subsequent management. Patients[apos] agreement with the diagnosis, and their willingness to view the condition from a psychological perspective was associated with favourable psychological treatment and better reported outcomes. The data suggested this in a retrospective correlative study. This important finding must be replicated in a controlled prospective study.