Abstracts

Rationale: Psychogenic non-epileptic seizures (PNES) are events that resemble epileptic seizures (ES) but without epileptiform activity. While continuous video-EEG monitoring allows correct diagnosis of PNES, remission of PNES is low. As the outcome of PNES varies according to the therapeutic approach, this study evaluated the outcome of a small cohort of patients who were referred to a psychiatrist for evaluation and management of PNES and psychiatric comorbidities at the time of their diagnosis. Methods: This retrospective cohort analysis included 12 patients evaluated for spell characterization at the South Texas Comprehensive Epilepsy Center (STCEC), between 2008 and 2010. The study was approved by the University of Texas Health Science Center IRB office. All the patients underwent continuous video EEG monitoring and were diagnosed as having PNES, three of them also had epileptic seizures. Demographic variables were evaluated such as age, gender, marital status, education level, employment, while clinical variables included age at onset and duration until diagnosis of PNES, associated diagnoses of epilepsy or psychiatric disorders, and use of psychotropic medications. All of the patients included in this study received psychiatric evaluation and treatment at the time of their diagnosis.The patients were followed for 6 months, they were seen in a monthly basis Results: Most of the patients were females (83%) who received at least high school level education. Three (25%) of the patients also had ES related to head trauma. All of the patients having ES as well as PNES had a history of abuse as adults. The most frequent psychiatric diagnoses were generalized anxiety disorder followed by depression. At 6 months follow up, six (50%) patients reported cessation of PNES, four (33%) reported a decrease in the frequency and intensity of PNES, and one reported an increased of PNES. 92% of the patients were taking SSRIs. One patient did not continue treament. Conclusions: In this cohort we found that PNES resolved or were reduced in 83% of patients in 6 months follow up. This can be explained by prompt diagnosis and initiation of pharmacological treatment. It appears that adequate management of Generalized Anxiety Disorder produced a good outcome of PNES, while borderline personality disorder appears to carry a bad prognosis.