PNES in Children: Efficacy of an Interdisciplinary Program
Abstract number :
2.36
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2022
Submission ID :
2204909
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:27 AM
Authors :
Nishtha Gupta, B.S. – Wright State University; Rajkumar Agarwal, MD – Dayton Children's Hospital; Lathisha Gathers-Hutchins, PhD – Dayton Children's Hospital; Laura Hart, APRN, FNP-C – Dayton Children's Hospital; Gogi Kumar, MD – Dayton Children's Hospital
Rationale: The optimal management of psychogenic nonepileptic seizures (PNES) in children requires collaborative approach between different specialists. A multidisciplinary clinic dedicated to evaluation and management of PNES may have a positive impact on various outcome measures of PNES.
Methods: We conducted a retrospective chart-review at the PNES clinic at Dayton Children's Hospital. This is an interdisciplinary clinic held bimonthly where patients with an established diagnosis of PNES (by a video EEG) are seen. The team consists of a neurology nurse practitioner, a psychologist and a social worker. Patients seen in the clinic from May 2019 to March 2022 were included in the study.
Results: A total of 73 patients [females: 56 (77%), age 15.5 ± 2.3 years, Caucasian 74%, African American 16%] were seen in the PNES clinic during the study period. The median time to establish care in the PNES clinic after the diagnosis was made was 38 days (range, 0-1482 days, IQR 90 days). Thirty-one of 73 patients (42%) had more than 1 visit during the study period. Epilepsy as a co-morbid diagnosis was present in 5 patients (7%). Stressors attributed to PNES included family (n=40, 55%), social (n=38, 52%), academic (n=23, 32%) and traumatic events (n=20, 27%). Co-morbid psychiatric diagnoses included anxiety (n=54, 74%), depression (n=34, 47%) and ADHD (n=15, 21%). More than 85% patients that were seen in the PNES clinic established care with a mental health professional (psychologist and/or psychiatrist). This was significantly higher compared to the proportion of patients who successfully received psychology or psychiatry services after referral from the general neurology clinic (30% based on 2021 clinic data, p< 0.0001, chi-square test). The acceptance of PNES diagnosis was seen in 68% of the families at the initial visit. This increased modestly to 75% in patients who had more than 1 visit to the PNES clinic (p=0.530, chi-square test). All patients had a PNES action plan for school. Fifteen of 31 patients (48%) with more than 1 visit to the PNES clinic were seen in the emergency department for PNES related episodes after establishing care in the PNES clinic.
Health Services (Delivery of Care, Access to Care, Health Care Models)