PROFILE OF PSYCHOGENIC SEIZURES IN AN URBAN UNDERSERVED POPULATION
Abstract number :
2.101
Submission category :
Year :
2002
Submission ID :
1324
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
Ravi Yangala, Pradumna P. Singh, Geetha Chari, Judy Schaffer, Susan T. Herman. Epilepsy Center, Department of Neurology, University Hospital of Brooklyn, Brooklyn, NY; Department of Neurology, University of Pennsylvania, Philadelphia, PA
RATIONALE: Profile of patients diagnosed with nonepileptic psychogenic seizures in an urban medically underserved population is presented to emphasize the necessity of availability of continuous video-EEG monitoring units for early diagnosis and to prevent potentially dangerous complications of antiepileptic drug usage.
METHODS: Retrospective review of patients admitted to a recently established urban epilepsy monitoring unit for diagnosis of recurrent paroxysmal events between July 2000 and December 2001. Patients were included if they underwent continuous video-EEG monitoring for atleast 24 hours. Patients with physiologic nonepileptic events were excluded.
RESULTS: Forty-three patients were diagnosed with nonepileptic psychogenic seizures. This represented 15% of a total of 286 patients monitored during the same period and 21.8% of monitored patients aged more than 10 years. The male: female ratio was 1:5.4. More than 60% of patients were between the ages of 11 and 40 years; only 5 (11.6%) patients were older than 50 years and 3 (6.9%) younger than 10 years. The mean duration of paroxysmal events prior to admission was 7 years and the median duration was 3 years. 15 (35%) had had events for less than 1 year. Most patients were receiving antiepileptic drugs (AEDs) at the time of admission- 51% were on one AED, 42% on 2 or more AEDs, and 30.2% on both AEDs and psychopharmacotherapy.
Mean duration of video-EEG monitoring was 4.5 days with a range of 1-8 days. Four (9.3%) patients had concurrent epileptic and psychogenic seizures recorded during the monitoring. Seizure phenomenology in psychogenic seizures was predominantly generalized shaking (37.2%), asymmetric jerking (39.5%) and pelvic thrusting (14%). Sensory symptoms were present in 9.3% and only one patient had urinary incontinence. Tongue injury did not ocur in any patient.
CONCLUSIONS: Psychogenic seizures were a common diagnosis in an intractable seizure population in this urban community. Early referral and establishment of diagnosis were accomplished in relatively high percentage of patients. Many patients were on multiple AEDs at admission and were exposed to the potential short term and long term side effects unnecessarily. This underscores the importance of accessibility of epilepsy monitoring units in underserved areas for early diagnosis and treatment.