Abstracts

Rationale: The best way to evaluate and treat patients with psychogenic nonepileptic seizures (PNES) is unclear. There is some emerging evidence that targeted psychotherapy, delivered through specialty centers, can lead to reductions in seizure frequency and ED utilization as well as improved quality of life [1, 2]. Team-based multidisciplinary approaches are increasingly being utilized to deliver care to patients with complex medical and psychologic issues that overlap various subspecialties. The Multidisciplinary Clinic for PNES in the Department of Neurology at Michigan Medicine was created to comprehensively evaluate and care for these patients. This project is aimed at assessing the baseline performance metrics of the clinic and longitudinal outcomes related to the care of these patients. Citations: 1. Salpekar J. Treatment Works, So Who's Afraid of PNES? Epilepsy Curr. 2019 Mar-Apr;19(2):1535759719841354. doi: 10.1177/1535759719841354. (PMID: 31012324). 2. LaFrance WC Jr, Baird GL, Barry JJ, Blum AS, Frank Webb A, Keitner GI, Machan JT, Miller I, Szaflarski JP; NES Treatment Trial (NEST-T) Consortium. Multicenter pilot treatment trial for psychogenic nonepileptic seizures: a randomized clinical trial. JAMA Psychiatry. 2014 Sep;71(9):997-1005. Methods: Patients evaluated in the Multidisciplinary Clinic for PNES are 18 years old or older, diagnosed with PNES via continuous video electroencephalography (EEG), and referred at the time of diagnosis in the Michigan Medicine Epilepsy Monitoring Unit (EMU) or through external clinic referrals. In this clinic model, a team consisting of a neurologist, psychiatrist, psychologist, and social worker comprehensively evaluate each patient. Each team member is also trained in the delivery of individual cognitive behavioral therapy informed psychotherapy and are assigned as therapists to patients using Taking Control of Your Seizures: Workbook (Treatments That Work) by Reiter et al. Through the use of various psychometric measurements, quality of life scales, functional assessments, and seizure logs gathered at clinic visits, key outcomes are being tracked to evaluate the feasibility and efficacy of this novel multidisciplinary clinic design. Results: There were 355 patients referred to the clinic from 9/2016 through 4/2019, of which 120 were evaluated at an initial visit. The average wait time after referral was about 5.5 months. 82% of the scheduled referrals showed up to their first visit. 88 of the 120 patients seen (73%) were deemed candidates for CBT based therapy. 44 of the 88 therapy candidates (50%) dropped out of treatment. Conclusions: There is a substantial need for multidisciplinary, comprehensive evaluation and treatment for patients with PNES. Even with implementation of novel multidisciplinary clinic models to address this need, access to these resources remains difficult for patients who have PNES. An increased delay between time of referral and initial clinic evaluation for patients with PNES may be correlated with greater risk of loss to follow up. Additionally, there is a substantial number of patients who begin treatment and then drop out. Further research on this patient population, it’s characteristics, and factors that impact response to CBT based therapy is needed. Funding: No funding