Abstracts

Rationale: To identify semiological characteristics of patients with psychogenic no epileptic seizures (PNES) with Video- EEG using a new classification system in a developing country Methods: A retrospective analytical observational study was carried out in patients admitted to Centro Medico Docente la Trinidad (CMDLT, Caracas Venezuela) who presented non-epileptic psychogenic seizure during Video-EEG studies performed between 2013-2017. Patients were classified in 4 groups according to the semiological presentation of the seizures: generalized motor (hypermotor), akinetic, focal motor and subjective symptoms. Inclusion criteria: Patients older than 14 years old with diagnosis of PNES. Exclusion criteria: Patients with definite diagnosis of epilepsy Results: 365 Video-EEG studies were performed with 38 patients meeting the inclusion criteria (10.41%); 76% women and 24% men. Mean age 32 years (range 17 to 63). Working population 57, 89%; mean education years 14. Mean onset of PNEs 28 years. Time with PNES until diagnosis 7 years. Video-EEG study sensitivity for PNES corrects diagnosis 94%. Average time of recording 2 days. 98% of patients were on medication with AEDs, 66% taking =3 AEDs, two taking 8 AEDs. 18% had a history of status epilepticus and admission to ICU. According to the semiological characterization 58% of subjects had hypermotor seizures (observed more frequently in younger than 32 years old (p: 0.046) with pelvic thrusting the most prevalent 36%, followed by head lateralization movements in 26% and pedaling in 13%); Pedaling hypermotor seizures were statistically more prevalent in young men (33% p: 0.05). Focal Motor type was most prevalent in men 56%. Akinetic seizures were observed in 52% of patients (62% were women (p: 0.03). Subjective symptoms were observed in 39% and motor focal seizure in 37% of patients. Subjective Symptoms type seizures were more prevalent in women (41 vs 33%); and more prevalent in younger women (p: 0.007). A trigger factor was identified in 82% (p: 0.03) of women: depression (55%), fear and frustration (14%) and academic failure (10%). Family dysfunction, love relationships and academic failure factors were only identified in women Conclusions: 1. 365 patients were evaluated. 38 subjects met our inclusion criteria.2. 76% were women and 24% men. Mean age: 32 years. Mean age of PNEs onset 28 years. Time with PNES until diagnosis 7 years.3. Video-EEG study sensitivity for PNES correct diagnosis was 94%.4. 98% of patients were on medication with AEDs, 66% taking =3 AEDs.5. 21% of PNES were spontaneous; induction test was required in 79% of patients. 6. We found 58% hypermotor seizures (observed more frequently in younger than 32 years old (p: 0.046) with pelvic thrusting the most prevalent 37%, followed by head lateralization movements in 26% and pedaling in 13%); 7. Pedaling hypermotor seizures were statistically more prevalent in young men (33% p: 0.05). 8. Motor focal seizures were observed in 37% of patients.9. Akinetic seizures were observed in 53% of patients, (62% women (p: 0.03).10. Subjective symptoms were presented in 40%, more prevalent in younger women (p: 0.007)11. A trigger factor was identified in 82% (p.0.03) of women: depression (55%), fear and frustration (14%) and academic failure (10%). 12. This is the first study in an Epilepsy Center in Venezuela, in which the recently proposed PNESs classification system was used and proved to be useful. Funding: No funding was recieved