Abstracts

Rationale: Pseudoseizures (PS) are a common type of non-epileptic spell encountered by physicians in different specialties. PS is diagnosed only by documenting the lack of ictal electroencephalogram (EEG) activity during a spell, preferably by a continuous Video-EEG study (V-EEG). Studies have shown that an early diagnosis of PS results in a better prognosis. However, most patients do not get diagnosed early. This may be related to lack of access to V-EEG, inability of physicians to recognize the problem to prompt a referral for V-EEG, and the attitude of many physicians that patients with PS are “fakers”. The purpose of this study was to gain an understanding of attitudes and beliefs among non-neurologist physicians (family medicine [FM], internal medicine [IM], and emergency medicine [EM]) who are likely to encounter persons with PS.Methods: The Ohio State University Central Physician Database was reviewed. Physicians in the central Ohio region who listed FM, IM or EM as their specialty, and had a published E-mail address were selected. A sixteen question, online survey was developed for a secure website. The survey was designed to learn about referral patterns and comfort level in diagnosis of PS, beliefs about etiology of PS as well as opinions about diagnosis, treatment and prognosis. Results: One-hundred and eighty-three physicians were identified and sent email invitations to participate in the survey. 72 surveys were completed (39%). Of responders 39% were female and 47% were in residency training. 50% (36) were IM, 33% (24) FM and 17% (12) EM. 85% felt that the term PS is appropriate to describe this condition. 54% believe that they can definitely diagnose PS upon witnessing a spell. 47% believe that inducing the spell at bedside confirms PS but only 26% try to induce one. 58% believe that V-EEG is not needed to establish a PS diagnosis and most patients should be referred to neurologists (83%). 94% stated that prolactin level has no value in diagnosing PS. 74% believe that PS are involuntary events, best treated by counseling and psychotherapy (92%), and occur more commonly in women (74%). 53% restrict driving privileges of patients with PS. Only 17% felt that patients with PS get significant improvement of their condition and 75% indicated that patients do not accept the diagnosis. Attitudes of the three groups of physicians were similar in most aspects. IM physicians reported they could differentiate PS from epileptic seizures more than the other two groups (p=0.037) once they witnessed an event. On a scale from 1-10, EM physicians had the highest confidence level in dealing with PS patients (6.2 vs 4.3 for FM vs 4.2 for IM, p=.025). Conclusions: This survey showed that there are many misperceptions around the diagnosis, treatment and prognosis of PS. This includes the need for V-EEG to establish the diagnosis, the fact that most patients with PS are not malingerers, and that even experts in the field can misinterpret a witnessed event. Since patients with PS are likely to be seen first by non-neurologists, it is important to educate referring physicians about this condition.