Abstracts

Rationale:
EMU admission with video EEG (vEEG) is the “gold standard” for diagnosing psychogenic non epileptic events (PNES) and is a routine part of pre-surgical evaluations for intractable epilepsy.  There is limited research on patient satisfaction with EMU evaluations, limited research on how EMU admissions impact PNES frequency,  and no published studies of the patients who are monitored in the EMU but have no events (NoE)  during monitoring.  Our goals were to:  1) Assess reported change in symptoms and patient satisfaction with their EMU experience following vEEG at our institution; 2) Compare reported change in symptoms and satisfaction between patients who do and do not have events (NoE) during vEEG; and 3) Compare reported change in symptoms and satisfaction between patients who had Epileptic Seizures (ES), PNES, and NoE during vEEG.
Method:
EMU patients were identified via chart review as part of a prior study. This sample included 138 unique patients evaluated more than 12 months prior to our contacting them. We did not attempt to contact 13 patients identified as intellectually disabled and one patient was deceased. Patients were contacted by phone.  After providing informed consent patients were asked to verbally complete a 10-minute questionnaire about their EMU experience, changes in medical treatment, and symptoms since vEEG.   Patients were called a maximum of two times. Results38 patients and one caregiver (whose responses were not included in analyses) responded to the questionnaire.  Responders versus non-responders did not differ in age at time of admission, gender, results of VEEG, or time since onset of seizures.  We hypothesized that NoE patients would be less likely to report a decline in frequency and less likely to report satisfaction with the EMU experience.  Group comparison data are presented in Tables 1 and 2. There were no apparent between group differences in change in event frequency or satisfaction (i.e., about 60% of all groups reported improvement in events and about 95% of all groups said they were satisfied with their EMU stay).  Although not part of our planned comparisons, about 40% of NoE patients reported ED visits post-EMU stay compared with about 30% of ES and PNES patients.
Conclusion:
More than 1 year after vEEG a majority of patients reported a decrease in event frequency regardless of whether they had events during monitoring and patients with confirmed PNES and NoE patients were equally likely to report a decline in event frequency.  Patients reported a very high rate of satisfaction with their EMU stay.  A larger sample size would be needed to have sufficient power to detect a difference in ED visits post-EMU evaluation in NoE versus PNES patients.  Although patients were informed that their responses would be kept confidential, patients were not anonymous and that may have resulted in patents being less willing to report a negative EMU experience. There were no obvious differences in patients who responded compared with patients who did not respond to our phone calls, but patients who were not satisfied and had a worse outcome may have been less likely to respond, which could also impact results.
Funding:
:none