Abstracts

Retrospective series reported that only 35% of adults diagnosed with psychogenic nonepileptic seizures (NES) became free of seizures. A prospective study is indicated to learn of seizure and social outcomes, and factors that might predict outcome. Since 1995, all adult patients diagnosed to have NES by successful video-EEG recording of typical attacks are prospectively followed by a medical social worker by telephone or by person at 3 months and 12 months after diagnosis. The contacts promoted patient education on the diagnosis of NES, encouragement to obtain mental health treatment (counseling, therapy, psychotropic medications), and assessment of NES activity and social function. Only patients with a sole diagnosis of NES were included in this study. Excluded were patients with concomitant epilepsy, or physiologic non-epileptic events. Through 2002, 94 patients have been enrolled. 23 patients (24%) dropped out from loss of contact, leaving 71 with complete follow-up at 3 and 12 months. A majority (86%) were women. At one year, 41 (Group I, 58%) were free of NES, 11 (Group II, 15%) had a major reduction to rare NES, but 19 (Group III, 27%) showed no improvement. The results at 3 months predicted outcome at one year. The NES free rates at 3 months were: Group I, 62%, Group II, 20%, Group III, 0%. There were no significant differences in the duration of disease, psychological diagnoses, and history of physical or sexual abuse, or rape amongst the groups. Group I patients verbalized self report of extreme situational stress more often (80%) as compared to the other groups. All Group I and II patients indicated an understanding of the diagnosis of NES by being able to verbalize what their diagnosis was at 3 and 12 months, but only 42% of Group III patients were able to do so. Social function at 1 year reflected NES outcome with return to work/school: Group I 90%, Group II 56%, Group III 5%, and with driving status: Group I 84%, Group II 36%, Group III 26%. Premorbid social function also predicted NES outcome. The proportions at work/school before diagnosis were: Group I 83%, Group II 45%, and Group III 26%, while the proportions dependent on disability-based income were: Group I 17%, Group II 36%, and Group III 58%. In this prospectively followed series of NES patients who received post-diagnosis education and encouragement as the main intervention, 58% became free of attacks. Predictors of 1 year outcome with regards to NES and social function are: premorbid work and disability status, an ability to verbalize an understanding of NES diagnosis, and seizure status at 3 months.