Abstracts

Rationale: Psychogenic seizures (PNES) are common in both civilians and U.S. Veterans. We have previously shown that Veterans diagnosed with PNES have higher health care utilization (HCU: outpatient visits, ED visits, hospitalizations) as compared to patients with epileptic seizures (ES), with only a transient decrease in HCU following diagnosis and conventional treatment. Radiologic procedures are another measure of HCU, and have the advantage of surveying both neurologic and non-neurologic disorders. The current study compared radiology utilization of PNES and ES patients, for 3 years before and after Epilepsy Monitoring Unit (EMU) diagnosis.Methods: Retrospective chart review included all patients meeting research criteria for PNES or ES at the Portland VA Medical Center (PVAMC) EMU, 2004-2012. Patients with both ES and PNES were excluded. All patients had 3 years of continuous VA medical records before and 3 years after the diagnostic EMU admission. The chart review utilized 2 sources: (1) the PVAMC electronic medical record and (2) linked medical records from other VAMCs. For each patient, we included all radiological procedures with documented reports. Results were compiled for the first year following EMU discharge, and the second and third years post discharge, and were compared to the same intervals during the 3 years prior to EMU admission. Statistical comparisons utilized Wilcoxon and Signed-rank tests.Results: 26 PNES and 27 ES patients met inclusion criteria. The total number of radiological procedures was higher in patients with PNES as compared to those with ES (median of 14 vs. 8; p<0.05). Overall rates for radiologic studies did not change between the 3 years pre-EMU admission and the 3 years following EMU admission. A transient decrease in radiology procedures during the first year following EMU admission reflected relatively high utilization during the year prior to admission (Figure 1). Brain imaging accounted for only 11% of all radiologic procedures in PNES patients (vs 30% in the ES group; p < 0.01). There was a reduction in brain imaging following PNES diagnosis (p<0.05), however, this had minimal influence on overall radiologic utilization.Conclusions: Radiology utilization was significantly higher in Veterans with PNES as compared to those with ES. Neuroimaging comprised a small minority of radiological studies in PNES patients, reflecting the diverse medical complaints in this group. Following EMU diagnosis of PNES there was no decrease in overall radiology utilization, although neuroimaging rates decreased. These results provide additional evidence that HCU does not decrease following diagnosis of PNES, and emphasize the need for more effective management.