Abstracts

Rationale: The purpose of this study is to determine if community neurologists and epileptologists are utilizing best practices when determining a diagnosis of nonepileptic seizures and to determine if there are available resources for psychological treatment of epilepsy (ES) and nonepileptic seizures (NES). This survey is an extension of a study conducted by LaFrance et al¹ that summarizes national practices and subsequent care offered to NES patients.

Methods: Surveys were sent out via Google Forms. The 11-item survey "Non-epileptic Seizures Survey" measured providers understanding of NES.

Results: Respondents were 83 neurologists. Providers consider the following risk factors for NES: physical/sexual abuse (93%), Posttraumatic Stress Disorder (88%), anxiety (87%), and depression (77%). Respondents suspected nonepileptic seizures when patients failed stereotypical events/or have multiple seizure semiologies (82%), had long seizure duration (75%), had a co-existing psychological disorder (69%), reported eye closure (68%), and were refractory to epileptic drugs (66%). Over 90% of respondents had access to an Epilepsy Monitoring Unit (EMU), including all responders who do not work in academic hospitals. One respondent who works in an academic hospital in a rural setting had no resources for his/her ES or NES patients. Respondents reported community mental health and psychiatry were available for referral for patients with ES and NES, but those in non-academic settings reported less access to these resources (Figures 1 and 2). 83% of respondents considered psychological treatments to be effective for treating NES whereas 59% agreed that psychological treatments are effective for treating ES. 12% did not know if psychological treatments were effective for both populations.

Conclusions: The results of this survey suggest that respondents had knowledge of risk factors for NES, although a smaller portion of respondents (45%) considered head injury to a be a risk factor. Respondents reported community mental health and psychiatry were available for referral for patients with ES and NES. In addition, neurologists in academic settings have more access to resources for NES and ES compared to respondents in non-academic hospitals. These findings indicate additional education regarding brain injury as a risk factor for NES is necessary, the need for studies comparing outcome data of psychological treatment of NES and ES is warranted, and more access to psychological resources is needed for neurologists in non-academic settings to better serve these populations. Without proper resources for NES patients in the community, this population is at risk for increased mortality, as shown in a recent study by Nightscales et al² where patients with NES have a standardized mortality ratio 2.5 times above the general population.

Funding: Please list any funding that was received in support of this abstract.: No funding was received in support of this abstract.