Abstracts

Psychological nonepileptic seizures (NES) are sudden paroxysmal alterations in consciousness, behavior, sensory-motor function or autonomic activity without epileptiform correlates that are often misdiagnosed as epileptic seizures. Definitive diagnosis occurs with video EEG long term monitoring (LTM), usually conducted during admission to comprehensive epilepsy centers. Although many newly diagnosed NES patients are referred for psychiatric or psychological treatment of a presumed underlying emotional disorder, others are simply discharged without clear direction or recommendations. A recent NINDS/NIMH/American Epilepsy Society (AES) sponsored international NES Treatment Workshop (Washington, DC, May 2005) identified a lack of knowledge in the field regarding standard of care in the management of patients with NES., We administered a preliminary survey to AES members via web and on paper to determine actual post-diagnostic instructions given to patients and referral practices, or NES [quot]treatment as usual[quot] (TAU)., Half of the 90 respondents were neurologists, 12% were neuropsychologists / psychologists, and 9% were psychiatrists, from 12 countries and 25 states. Video EEGs were done at 80% of the sites, and LTM is used in one-third of the sites to confirm NES diagnosis. Provocative testing was used at half of the sites. All respondents reported discussing the diagnosis of NES with the patients, and 91% discuss with the family. The term most often used for the events was [quot]nonepileptic seizures[quot], and stress, anxiety/depression, and past trauma were the three etiologies most commonly given to the patient. Treatment was recommended by 95% of the respondents, and 69% of neurologists continued to follow the patient after NES diagnosis. Referrals were most commonly made to psychiatrists and clinical psychologists for treatment. The respondents thought that NES education, psychotherapy, and psychopharmacologic interventions were the most effective treatments. AEDs were tapered by 77% of the respondents, and 37% prescribed psychotropics if comorbid diagnoses were made., The preliminary survey results are intended to inform clinicians and researchers about the range of standard practices among physicians and allied health professional members of AES regarding their responses to NES patients. The survey addresses what neurologists and clinicians discussed with patients about the diagnosis of NES, the terms used to describe the episodes, and the recommendations for treatment. The final survey will summarize national practices, and the range of care, or TAU, offered to patients with NES., (Supported by American Epilepsy Society Research and Training Workshop Award.)