Abstracts

Rationale:
Psychogenic non-epileptic seizures (PNES) resemble epileptic seizures in semiology without the associated abnormal EEG. Studies have found a continued lack of understanding of pediatric PNES in both providers and patients leading to misdiagnosis, miscommunication, poor outcomes and unnecessary costs. This results in poor quality of life and hinders normal development and learning. Therefore, increasing knowledge of PNES in pediatric settings is crucial to better understand and improve treatment of this disorder.
Method:
Data consists of a comprehensive collection of variables related to PNES extracted retro-prospectively in a chart review from Le Bonheur Children’s Hospital between January 2012 to the present. The “PowerInsight” reporting tool was used to extract data from the Cerner database. Patients ages 8-18 were identified based on ICD 9 and 10 code assignments for conversion disorder including PNES. 
Results:
Patients diagnosed with PNES or conversion disorder (n=30) are on average 16 years of age, primarily female (86.7%) and predominately African American (60.0%). A majority of families have public insurance (93.9%). A patient with PNES typically appears at Le Bonheur with an already established medical history that includes neurological and psychological issues. It is common for patients to be prescribed both antidepressant (50.0%) and anti-epileptic (65.4%) medications prior to diagnosis. Patients exhibit many different comorbid psychological disorders (see figure 1), however they rarely have epilepsy (21.6%). There are also various other comorbid medical issues patients exhibit including chronic pain (35.1%), migraines (27.0%) and GI illnesses (40.5%). During a typical visit, a patient with PNES or conversion disorder symptoms usually have neurological (55.3%) and psychiatric (44.7%) evaluations, however they do not typically receive a neuropsychological evaluation (5.3%). About 45.9% of patients reported an experience of a traumatic or stressful event prior to the onset of the disorder. School difficulties was the most prominent traumatic/stressful event over family difficulties and physical, sexual or emotional trauma (see figure 2). Once diagnosed, a standard plan for treatment is not clear with only 65.8% of patients being referred to a mental health provider and 47.4% receiving psychoeducation about their diagnosis. The most common referral for therapy was general counseling (59.5%) and only 31.6% of patients had a follow up appointment with a psychiatrist after diagnosis.    
Conclusion:
Findings from this racial and socioeconomically inclusive study will help us understand the current state of clinical care for children in underserved areas in the short run. In the long run, findings will aid in developing a standard protocol of care to be implemented universally. This aligns with the mandates of the ILAE PNES-task force to improve pediatric PNES healthcare. Reilly, C., Menlove, L., Fenton, V., & Das, K. B. (2013). Psychogenic nonepileptic seizures in children: A review. Epilepsia, 54(10), 1715–1724. https://doi.org/10.1111/epi.12336 Reuber, M., & Brown, R. J. (2017). Understanding psychogenic nonepileptic seizures—Phenomenology, semiology and the Integrative Cognitive Model. Seizure, 44, 199–205. https://doi.org/10.1016/j.seizure.2016.10.029 Kanemoto, K., LaFrance, W. C., Duncan, R., Gigineishvili, D., Park, S.-P., Tadokoro, Y., Ikeda, H., Paul, R., Zhou, D., Taniguchi, G., Kerr, M., Oshima, T., Jin, K., & Reuber, M. (2017). PNES around the world: Where we are now and how we can close the diagnosis and treatment gaps—an ILAE PNES Task Force report. Epilepsia Open, 2(3), 307–316. https://doi.org/10.1002/epi4.12060    
Funding:
:Neuroscience Shainberg Fund.