Abstracts

Rationale: Patients with psychogenic non-epileptic seizures (PNES) are frequently encountered in epilepsy monitoring units (EMU) and account for >25% of admissions. Many of these patients suffer the same disabilities as patients with poorly controlled epileptic seizures (ES). PNES are also common in patients cared for through the Veterans Administration hospitals but the population and health care system are in many ways different from those of the civilian population. We report on the characteristics of veterans with PNES and contrast these with a timed matched series of civilians with PNES. Methods: We reviewed charts of 150 consecutive veteran admissions to the EMU at the Portland VA Medical Center (VAMC). Each chart was abstracted for age at admission, time interval from historical onset of typical spells to the diagnostic EMU admission, antiepileptic drug (AED) usage at admission, cumulative AED usage, and other information. Final diagnoses were reviewed in light of the EMU admission findings, and all available historical information. All patients were assigned a final diagnosis of (a) ES; (b) PNES; (c) other non-epileptic seizures; (d) mixed epileptic and non-epileptic seizures; or (e) non-diagnostic. Criteria for PNES required (a) recorded spells typical of the patients habitual episodes; (b) spells with bilateral motor activity and/or alteration of consciousness; (c) clinical semiology suggestive of PNES; (d) no associated ictal patterns on EEG; (e) no interictal epileptiform discharges; and (f) no historical documentation of epileptic seizures. The Portland VAMC EMU also admits civilian patients through a sharing contract with the Oregon Health & Science University. The comparison group consisted of all civilian PNES patients diagnosed over the same time period, using the same criteria, and evaluated by the same physician team. Statistical comparisons used the 2-group Wilcoxon test. Results: Three veterans were excluded from the analysis. Fifty-five (37%) had nondiagnostic admission(s); 41 (28%) met research criteria for PNES; 31 (21%) had ES; 13 (9%) had other non-epileptic events; and 7 (5%) had mixed PNES and ES. As compared to the civilians, veterans with PNES were older at admission (median age 51 vs. 40; p<0.01) and were more often male (80% vs. 20% of civilians). Veterans had a median interval of 84 months from onset of the habitual seizures to the diagnostic EMU admission, as compared to 24 months in civilians (p<0.001). Total accumulated AED usage was higher in veterans than civilians (p<0.05) though both groups used a median of 1 AED at the time of admission (NS). Conclusions: PNES are a common problem within the veteran population. As compared to civilians the diagnosis is likely to be missed for a considerably longer period of time.