Abstracts

Rationale: Psychogenic non epileptic seizures (PNES) are challenging conditions to diagnose and manage. The opinion of the health care provider (HCP) towards the patients and the disease is of paramount importance and several lacunae remain to be stressed. Amongst HCP, opinion of nurses has not been adequately explored. We attempted to identify areas which need more emphasis to provide optimal care to the patients. Methods: We approached physicians (attending and resident) of primary care, neurology, psychiatry and licensed nurses regularly taking care of patients of PNES. An anonymous questionnaire (Table 1) was provided to the respondents to be filled out. Results: Net 124 respondents responded to our survey. Sixty (48.3%) were from primary care, 12.9% from neurology and 7.2% from psychiatry. Thirty-nine (31.4%) respondents were practicing nurses. Amongst physicians 68.2% were resident physicians. Non epileptic seizures was by 35.7% (39/109) as a diagnostic term as against pseudo-seizure (22.9%), stress related seizures (18.3%), psychogenic seizures (13.7%), functional and fake seizures (4.5% each). On a numerical scale of 0-10 neurologists reported highest average level of confidence in managing patients of PNES (7.58) followed by nurses (7.15) Majority (60.1%; 62/103) believed that patients have no control over the spells and they are involuntary. Amongst 106 respondents, 69 (65 %) opined that video EEG should always be used in making a diagnosis of PNES. While 66.3% (71/107) respondents would agree with the diagnosis of PNES by an epileptologist, 27.1% would decide on a case to case basis and only 6.5% would disagree. Psychiatry was felt the best specialty to manage patients after diagnosis (36.4%) followed by neurology (28.4%), psychology (22%) and primary care (12.7%). These responses were not mutually exclusive. Of 102 respondents, 71.5% would not adjust AED after an increase in spell frequency. 56% (9) neurologists expressed that they may adjust AED before an epileptologist's evaluation. Only 14% (15/107) felt that the patients be allowed to drive in wake of continuing episodes while the rest either would not support driving (45.7%) or decide on a case-to-case basis (40.1%). Conclusions: Several important aspects of HCP s opinion towards PNES are revealed. The age old term pseudo-seizure seems to have lost favor. Neurologists and nurses have among the highest level of confidence in managing patients of PNES. Interestingly, more than a third of respondents felt that patients of PNES have voluntary control over their episode. Amongst HCP highest percentage of nurses would agree with the diagnosis of PNES by an epileptologist. While majority of responders would not adjust AED before evaluation by an epileptologist, more than half of the neurologists would. A multi-specialty approach to the management of PNES seems to be the most preferred methodology with maximum participation by psychiatrist, neurologist and psychologist. Importantly, only minority (<15%) would allow unrestricted driving in patients with continuing episodes.