Abstracts

Rationale: While lower scores on the Dissociative Experience Scale (DES) has been known to be associated with better outcome for psychogenic nonepileptic events (PNEE), very little is known whether the degree of ictal sensorium (determined clinically at bedside) could affect outcome (Reuber et al., 2003). To explore this question, we compared the short term outcome of PNEE among patients with and without the presence of dissociative sensorium during their events of interest as captured by Video-EEG (VEEG) recording.Methods: We prospectively enrolled veterans admitted to the epilepsy monitoring unit (EMU) at the Michael E. DeBakey VA Medical Center, Houston, TX, from December 2008 until January 2011 with a VEEG confirmed diagnosis of PNEE. We then divided our enrolled patients into either intact or impaired ictal sensorium groups based semiologically on the retention of memory recall and verbal responsiveness during the captured events. Following discharge from the EMU, each enrolled subject had a phone interview after 1 month, 3 months, and 6 to 12 months. They were asked to rate the frequency and severity of their events, their family, health, occupational and social functioning, and their quality of life (QOL) in a scale of 1 to 5. Furthermore, they answered 5 multiple choice questions (MCQ) assessing the patients understanding and retention of the diagnosis explanation that was verbally discussed at the time of discharge.Results: Patients who could not be reached at each interview juncture were excluded from the study. Forty seven patients met the inclusion criteria and completed all follow-up phone calls. Fifteen patients were categorized as having intact ictal sensorium (age 43.3 +/- 15.5) and 32 as having impaired ictal sensorium (age 43.4 +/- 13.5). Higher percentage of patients having intact ictal sensorium reported improvement (i.e. by 50% or greater compared to pre-VEEG diagnosis) in the frequency or severity of their events at month 3 (80% versus 34.4%) and month 6 (66.7% versus 25%) (p-value 0.005 and 0.01, respectively). There was no statistically significant difference in percentages of improvement between these groups at month 1. In addition, no significant differences were reported between the two groups when comparing their mean MCQ scores, their reported family, health, occupational or social functionalities, as well as the overall quality of life at month 1, month 3, or month 6 to 12.Conclusions: We observed a higher rate of improvement in the frequency or severity of events in patients with PNEE with intact itcal sensorium as compared to those with impaired ictal sensorium. However, this finding does not necessarily translate to a better level of functionality or overall quality of life in this group.