Abstracts

Rationale: The assessment and diagnosis of psychogenic non-epileptic seizures (NES) in inpatient epilepsy programs is very common (30-40% of admissions). However, these patients are often not followed closely by an Epileptologist after discharge. The aim of this study was to describe the natural history of spells in patients with confirmed psychogenic NES, and specifically whether their satisfaction with the diagnosis affected the likelihood of their spells remitting. Methods: The sample consisted of 28 patients admitted to the adult inpatient epilepsy unit from 2006-2007 who were diagnosed with pure psychogenic NES via video EEG. The determination of a pure psychogenic etiology was made via chart review, neuropsychological assessment, and by ruling out physiological causes. Once identified, the patients were contacted by telephone and completed a directed interview. The questions related to current seizure status, the use of psychological support services, and quality of life. Patients also answered questions about the conference during which the diagnosis of psychogenic NES was presented, including their level of satisfaction with the diagnosis. Results: There were 28 psychogenic NES patients who completed the telephone interview. Of the respondents, 43% reported that they were currently seizure-free. Regarding the meeting where the diagnosis of psychogenic NES was delivered, nearly all patients were able to recall the meeting (93%). Patients’ understanding of the diagnosis varied, however, with a slim majority (57%) claiming they understood the diagnosis well. 53% expressed satisfaction with the diagnosis of psychogenic NES. Only 54% of patients attended a scheduled follow up appointment with the diagnosing Epileptologist after discharge. Similarly, only 33% of patients established care with a mental health provider following their hospitalization despite being referred. Conclusions: Despite sharing a common diagnosis of psychogenic NES, the patients who receive this diagnosis appear to follow a varied clinical course in terms of the persistence of their spells. A number of individuals become free of their spells within a relatively short period of time, while others continue to be affected. It is unclear based on the available data whether patient satisfaction with the diagnosis of psychogenic NES affects the attainment of seizure-free status. However, the findings do suggest that there is the potential to improve the transition from diagnosis to treatment of the root causes of psychogenic NES. Improving patient attendance of the follow up meeting with an Epileptologist and ensuring completion of referrals to mental health providers would both serve this goal.