Responsive Neurostimulation Device Use in Patients with Epilepsy and Psychogenic Non-epileptic Events. Case Report and Healthcare Expenditure Analysis
Abstract number :
2.064
Submission category :
3. Neurophysiology / 3E. Brain Stimulation
Year :
2023
Submission ID :
688
Source :
www.aesnet.org
Presentation date :
12/3/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Ahmad Sawalha, MD – Philadelphia College of Osteopathic Medicine.
Christopher Anderson, MD – Medical College of Wisconsin; Chad Carlson, MD – Medical College of Wisconsin
Rationale: Around 30% of the patients referred to tertiary care epilepsy centers for treatment resistant epilepsy have a diagnosis of psychogenic non-epileptic events (PNEE) and 27% of PNEE patients were incorrectly admitted to the ICU for status epilepticus management causing significant financial burden on the healthcare system. The coincidence of epilepsy and PNEE is around 10% making it challenging to manage clinical events conservatively without risking missing an epileptic seizure. Our objective was to analyze the utilization of intracranial recording of electrocorticogram (Ecog) using Responsive Neurostimulation (RNS) to differentiate epileptic seizures from nonepileptic events and its utility to reduce the financial burden on the healthcare system.
Methods: We obtained the healthcare records for a patient who has a dual diagnosis of epilepsy and PNEE from our electronic medical system. We analyzed the data and reviewed Ecogs from the RNS device. We compared the healthcare expenditure before and after RNS placement that are related to seizures management or characterization of clinical events as well as the cost of RNS placement.
Results: The RNS decreased the number of admissions and total healthcare expenditure for our epilepsy patient who has co-morbid PNEE by using the data generated by RNS remotely to characterize the patient’s clinical events. After RNS implantation, the number of admissions related to epilepsy management decreased to “zero” and the number of hours spent to review EEG for triaging her clinical events decreased from 528 hours to just eight hours. This resulted in successful weaning off multiple antiseizure medications and better quality of life. The total cost of care related to epilepsy management was reduced from $116,517 to $921 after RNS implantation.
Conclusions: Treatment with RNS in our patient with both diagnoses of epilepsy and psychogenic non-epileptic events lead to reduction in healthcare expenditure for psychogenic non-epileptic events specifically in addition to its benefit in reducing the frequency of epileptic seizures.
Funding: Not applicable.
Neurophysiology