Abstracts

The diagnosis of psychogenic seizures may not be established for several years, during which antiepileptic drugs (AEDs) may be used unnecessarily and appropriate psychiatric intervention delayed. Because some of our patients had taken more than four AEDs for more than ten years before the diagnosis of the psychogenic seizures, we elected to systematically study this population to determine the frequency and causes for delayed diagnosis and to analyze the negative effects of the delay. Data from 215 patients admitted for video-electroencephalography (VTEEG) during a nine month interval were analyzed. The diagnosis of psychogenic seizures was considered definite if clinical events were recorded on VTEEG that (1) were typical of that patient[apos]s usual episodes, (2) were devoid of epileptiform discharges, and (3) were characteristic of psychogenic seizures by visual inspection of the videotaped event. We analyzed patient demographic distribution, stratified risk factors, the duration from onset to diagnosis, and subsequent negative effects such as numbers and duration of unnecessary AED treatment, working status. Delayed diagnosis was defined as more than six month from onset to diagnosis. A total of 109 patients (50.6%) had psychogenic seizures. 33 %( 35) were male and 67% were female. The most significant risk factors are history of sexual abuse and psychiatric disorders. 30.3% of them had concomitant or history of psychiatric disorders, 28% had history of sexual abuse. Only eight patients were referred and diagnosed on presentation. 74% of these patients were diagnosed after six months. In the group of delayed diagnosis, the mean time from onset until diagnosis of psychogenic seizures was 54.3 months with range from six to 372 months. 36.8% of them were on one AED with mean duration of 37.03 months; 27.6% were on 2 AEDs with a mean duration of 87.9 months; 10.5% were on 3 AEDs with duration of 41.8 months; and 2.6% were on 4 AEDs with duration of 108 months. 41.3% of these patients were on more than one anti-epileptic drug with average duration of 79 monthsAbout 60% of these patients were not working and 20% of them were on disability. The diagnosis of psychogenic seizures is often delayed even with the wide availability of VTEEG. Delayed diagnosis of psychogenic seizure can impede appropriate medical management and have significant negative effects resulting in unnecessary AED treatment and loss of productivity. Neurologists should have a high index of suspicion and be sensitive to risk factors when encountering patients with[rdquo] pharmaco-resistant epilepsy[rdquo] and patients with symptoms suggestive of psychogenic seizures. Early referral to VTEEG should be considered. With this in mind, achieving earlier diagnosis and avoiding unnecessary use of AEDs in this population is a challenging yet achievable task.