Abstracts

Psychogenic, non-epileptic events, conversion disorder, or pseudo-seizures are all terms given to a disorder that resembles an epileptic seizure, but has no electrographic correlates. Patients with this diagnosis may be treated for years without the proper testing for an accurate diagnosis. Long term video-electroencephalographic (EEG) recording is the only procedure that can definitively diagnose non-epileptic events for appropriate treatment. Since many patients are seen and treated based on their seizure presentation and self-report, misdiagnosis frequently occurs. The purpose of this study is to assess the ability of health care providers to differentiate between epileptic and non-epileptic seizure activity. A secondary purpose was to compare seizure identification scores between nurses and physicians. A convenience sample of 118 health care providers (nurses, physicians, psychologists, medical students, and EEG technicians) who care for individuals with seizure disorders participated in this descriptive study. The majority of participants were nurses (38%) and physicians (41%). Videotapes with 10 randomly sequenced seizure-like events (50% epileptic) were viewed individually by all participants and scored as an epileptic or non-epileptic event. Each correct response was assigned 10 points. Points were summed for a total score. Higher seizure identification scores reflected more correct answers. Scoring was completed immediately after each participant completed the study. 118 participants completed the study. Scores for identification of epileptic and non-epileptic seizure activity ranged from 10 to 90 (M=51). Mean scores by groups of participants were: physicians=55.4, psychologists=51, medical students=49.6, EEG technicians = 55, and nurses = 46.2. It is notable that all these scores are close to chance levels (chance=50). A one-way analysis of variance ( ANOVA ) was conducted to compare physician and nurse seizure identification scores. Physicians scored significantly higher than nurses (F(1,117)=6.24,p=.01). Findings from this study suggest that visualizing seizure activity may not be the best way for health care providers to correctly identify epileptic vs. non-epileptic seizure activity. Long-term video EEG should be considered as an appropriate means for differentiation between epileptic and non-epileptic events.