Abstracts

Rationale: Psychogenic non-epileptic events (PNEE) are observable paroxysmal events that may resemble epileptic seizures but with no concurrent electroencephalographic abnormalities. The estimated lifetime cost in patients with PNEE is up to $900 million, including unnecessary diagnostic exams, laboratory tests, anti-seizure medications, lost income due to missed work, and emergency department utilization. The aim of this study was to measure the impact of our Nationwide Children’s Hospital PNEE clinic in reducing healthcare utilization in pediatric and adolescent patients diagnosed with PNEE.

Methods: To evaluate the effect of our PNEE clinic appointments, we reviewed the frequency of emergency department (ED) visits, urgent care (UC) visits, planned and unplanned hospitalizations, neuroimaging studies from 12-months prior to the clinic visit and 12-months following initial referral to the clinic. We then performed a manual chart review of all patients referred from November 2017 – March 2020. Descriptive statistics were used to describe patient demographics and frequencies of healthcare utilization; comparisons of healthcare utilization were performed using the Wilcoxon Signed Rank Test.

Results: Two hundred and twelve unique patients were included in this retrospective observational study. Patient gender was identified as 71% female, 28% male, and 1% other, with an average age of 14 years at diagnosis. Comorbid epilepsy was identified in 16% of study population (34/212) (Table 1). ED visits were the most common form of healthcare utilization with a total of 410 visits in 155 patients prior to being seen in the clinic which decreased to a total of 187 visits in 72 patients, (64% decrease). All measures of healthcare utilization decreased in the 12-months following the visit and statistically significant differences were observed in all measures of healthcare utilization except for head MRIs (Table 2).

Conclusions: Patients with PNEE were found to have decreased healthcare utilization in the 12 months following an appointment in the NCH multidisciplinary clinic, including significant decreases in emergency services and unnecessary diagnostic testing, in the 12-months following the visit.

Funding: Please list any funding that was received in support of this abstract.: No external funding support was received for this work. Statistical analysis was supported by internal neurology funds.