Abstracts

Rationale: Epilepsy patients are known to have multiple comorbidities. Co-morbid psychiatric diagnoses contribute to poor outcome, especially undiagnosed psychiatric conditions1. The goal of this study is to properly identify specific psychiatric diagnoses in this patient population during Epilepsy Monitoring Unit (EMU) admission, and provide targeted treatment recommendation.  Methods: All patients admitted to EMU from October 2016 to May 2017 were included in this study. Psychiatric evaluation was completed for all patients except one due to family refusal (N=60). All patients had pre-existing epilepsy diagnosis or suspicion of epilepsy. Psychiatric evaluation included patient interview, family interview, chart review, and discussion with neurology team.  Results: 60% of these patients reported history of psychiatric illness. The majority of these patients were treated by their neurologist or primary care doctor for depression or anxiety. Three patients reported pre-existing Post-Trauma Stress Disorder (PTSD) with history of severe trauma. Three patients had autistic spectrum disorder diagnosed at young age, all related to early-onset epilepsy. Three patients had documented, pre-existing Psychogenic Non-Epileptic Seizure (PNES) or conversion disorder evidenced by negative EEG.  A few other psychiatric diagnoses were unrelated to epilepsy. Patients who reported no pre-existing psychiatric diagnosis (40%) had never had a psychiatric evaluation (Figure 1). After formal psychiatric screening at EMU, diagnosis distribution changed significantly (Figure 2). More than 50% of the patients with pre-existing diagnosis of depression or anxiety were found to have different types of somatic symptom and related disorders. With EEG correlation, eighteen patients were confirmed to have PNES or conversion disorder with mixed symptoms during EMU admission. Seven patients met the criteria of somatic symptom disorder with chronic, non-neurological symptoms. Six patients received new diagnosis of adjustment disorder; four of them were due to uncontrolled epilepsy. Five patients received new diagnosis of PTSD with severe early life trauma; among them, three patients also received another new diagnosis of chronic somatic symptom disorder. Conclusions: Proper diagnosis is the first step of treatment2. Psychiatric consultation with daily inpatient follow-up during EMU admission identified PNES, conversion disorder with mixed symptoms, other somatic symptom disorders and adjustment disorder related to epilepsy, which led to more targeted treatment recommendations.References: 1. Kanner AM. Management of psychiatric and neurological comorbidities in epilepsy. Nat Rev Neurol. 2016; 12(2):106-16.2. LaFrance WC. et al. Management of psychogenic nonepileptic seizures. Epilepsia. 2013; 54 Suppl 1:5 Funding: None