Abstracts

RATIONALE: A general neurologist often treats intractable seizures. However, some of these patients may not have epilepsy. Sometimes the diagnosis of NES is suspected, but often it is not. We attempted to identify features that may increase the suspicion of NES. METHODS: Of 206 consecutive admissions for video-EEG monitoring, 50 patients were diagnosed with NES. Retrospective chart review identified 46 of these as being previously followed by a general neurologist. Review included the determination on whether the neurologist had suspected NES (SNES) or did not suspect NES (NSNES). Records were assessed for clinical features and prior psychiatric history. RESULTS: 54% (25/46) of the patients with confirmed pseudoseizures had previously been suspected to have NES, while 46% (21/46) were previously unsuspected. Age and gender were similar in the two groups. However, the age of onset was younger in SNES (21 years) compared to NSNES (28 years) and there was a longer clinical history of spells; 12 and 5 years, respectively. In SNES the clinical spells were more frequent, with 76% (19/25) occurring at least every other day, compared to 57% (12/21) for NSNES. There was no significant difference in the number of anticonvulsants or motor manifestations in both groups. 25% (6/18) of patients in the SNES group had at least one abnormal EEG prior to admission with 4 having focal features, whereas 42% (8/19) were abnormal in the NSNES group with 3 focal. 60% (15/25) of patients in the SNES group had a prior psychiatric diagnosis, compared to only 29% (6/21) of the NSNES group. Multiple psychiatric diagnoses were documented in 30% (6/21) of SNES compared to 8% (2/25) for NSNES. Depression was the most common psychiatric diagnosis in either group; SNES-13, NSNES-5. 52% (13/25) of the patients in the SNES group had a history of significant psychological trauma or physical abuse, compared to 33% (7/21) of NSNES. CONCLUSIONS: NES were clinically suspected by a general neurologist when very frequent and associated with a long history. NES were more often suspected in patients with a prior psychiatric diagnosis, especially when multiple, and with a history of significant psychological trauma or abuse.