Abstracts

RATIONALE: The identification of clinical signs distinguishing non-epileptic psychogenic events (NEPS) from epileptic events have received considerable attention over the past few years. Studies have provided some evidence for differentiating the ictal and peri-ictal manifestations between NEPS and epileptic patients including particular motor manifestations, vocalizations, and emotionality. An interesting clinical observation noted over the years in our inpatient video/EEG seizure monitoring unit population, is that many non-retarded, late adolescents and adults present with various types of toy animals (e.g. teddy bears, dogs, etc) in their rooms. Anecdotally, it has been the staff impression that when this behavior is present, they are inevitably diagnosed with NEPS. The present study intends to provide quantitative analysis of this clinical observation and find out whether this was unique to NEPS patients or a product of hindsight bias.
METHODS: The database and records of the University of Alabama at Birmingham-Epilepsy Monitoring Unit were reviewed from October 1, 1999 to December 31 2001, in order to identify patients with the diagnosis of exclusive NEPS or epileptic seizures. Over this 27-month period 920 patients (over the age of 14) were admitted to the UAB inpatient video/EEG seizure monitoring unit who either received a diagnosis of epilepsy (n=470) or NEPS (n=430). An information data card containing demographics, as well as medical information, was created for all patients admitted, by our clinical nurse coordinator at the time of admission. Information on the presence of objects deemed unusual for a neurologically intact late adolescent or adult aged patient to be possessing while in the hospital was recorded. These items consisted primarily of toy animals. Those brought by others as gifts to the patients were not included.
RESULTS: A total of 23 patients (2.4%) were found with toy animals. Twenty were diagnosed with NEPS (p=0.0001, Fisher[scquote]s exact test), and 3 with epilepsy. Sensitivity was found to be 0.02% and specificity to be 99%, with a positive predictive value of 87% and negative predictive value of 52%. Interestingly patients with epilepsy who had animal toys had history of a psychiatric disorder.
CONCLUSIONS: Our results suggest that the presence of a toy animal (teddy bear, etc) indicates a high likelihood diagnosis of NEPS. The clinical use of this finding is limited, since it cannot be used for routinely diagnosis, but merely as an interesting observation. Etiology for such a behavior likely relates to the patient[scquote]s psychiatric profile and dysfunctional interpersonal relationship patterns.