Abstracts

Rationale: There is a paucity of research exploring differences in the presentation of psychogenic non-epileptic seizures (PNES) across different racial and ethnocultural backgrounds (Kanemoto K et al 2017). Hawaii is a diverse ethnocultural community, readily accessible for a study researching the effects of ethnicity on PNES and its different presentations. This pilot study set to compare differences in the semiology of PNES among patients of different racial or cultural background, with focus on those of Hawaiian ethnicity.  Methods: Patients with a diagnosis of PNES (classified as possible, probable, clinically established, and documented) were identified from an initial cohort of 139 patients that underwent video electroencephalography (vEEG) at a Hawaii-based neurosciences (HPN) practice for diagnostic purpose from 2014 to 2017. Patients were grouped by race or ethnoculture as follows: Caucasian, Asian, Hawaiian, and other. Clinical histories and vEEG were reviewed to characterize each patient’s PNES semiology as rhythmic motor, hypermotor, complex motor, dialeptic, non-epileptic auras, and mixed (Seveniratne, Reutens & D’Souza 2010). Cross-group comparisons on the PNES pattern were performed using descriptive statistics and chi-square tests. Results: vEEG and clinical history identified a group of 51 patients with possible to clinically-documented PNES. Hawaiians (n=17, 33%) were the highest represented, followed by Caucasians (n=16, 31%), Asians (n=4, 8%) and others (n=14, 28%). The presenting PNES semiology in Hawaiian patients was motor (47%), mixed (24%), dialeptic (18%) and non-epileptic aura (12%) of cases; in Caucasian, motor (38%), non-epileptic aura (38%), dialeptic (19%) and mixed (6%) of cases; and in Asians, dialeptic (50%), motor (25%) and nonepileptic aura (25%) of cases. Patients with PNES of Hawaiian ancestry were significantly less likely to present with non-epileptic auras in comparison to the rest of the group (p=.03285); neither Caucasian nor Asian semiology portrayed significant correlations. Conclusions: The ethno-cultural grouping of our PNES cohort differ from Hawai’i’s 2017 Census statistics in that patients of Hawaiian ancestry were over-represented (33.3% versus the State’s 10.2%) and Asians were under-represented (7.8% versus the State’s 37.7%). Asians in Hawai'i may be less likely to translate psychological stressors into PNES. Moreover, patients with PNES of Hawaiian ancestry were less likely to present with non-epileptic auras as part of their semiology. While two centuries of acculturation history might have predicted less prominent differences among these racial/ethnocultural groups, the results suggest that some cultural aspects are preserved which affect both the prevalence and semiology of PNES among patients of Asian and Hawaiian ancestry in the State of Hawai’i. The relatively small sample size is a limitation that will be addressed by extension of the current study to capture additional patients.  Funding: None