Abstracts

Rationale: Research has shown that 10 to 20 percent of children referred to epilepsy centers nationwide are found to have Psychogenic Non-Epileptic Seizures (PNES). PNES affects patients for a variety of reasons; some may experience this type of seizure due to psychological factors, such as anxiety, stress, or anger, while others may experience them due to physiological factors, such as overexertion or pain. Studies have shown that a child’s early diagnosis of PNES can lead to a 97 percent reduction in emergency department (ED) visits independent of cause. The goal of this study was to determine whether a multidisciplinary clinic consisting of an epilepsy nurse practitioner, epilepsy social worker, and a clinical psychologist (PNES clinic) at Nationwide Children’s Hospital has been effective in reducing ED visits for children diagnosed with PNES.Methods: In order to determine the effectiveness of the PNES clinic in the lives of the patients seen, the frequency of each patient’s emergency room visits were examined. A data report was generated of patients documented to have been diagnosed with psychogenic seizures after undergoing an EEG confirming events of concern were related to PNES. The list was then filtered to include only patients that were seen in the PNES clinic between the years of 2010 and 2014. Based on the above criteria, 71 patients were identified. With those patients identified, a thorough manual chart review was then conducted for each patient in order to record the number of emergency room visits one year before presenting to the PNES clinic, as well as the number of traipsed visits 12 months following the initial appointment at the PNES clinic.Results: Of the 71 patients included in the study, 79% were female, while 21% were male. The average age at the time of PNES diagnosis was 14.6 years, with an 8-27 year range. The median number of ED visits dropped from 1 [0.5 - 3] to 0 [0 - 0] (median [interquartile range], p < 0.001, paired Wilcoxon signed rank test). The number of individuals who had at least one ED visit dropped from 52 (73%) to 16 (23%) (p < 0.001, Chi-square test).Conclusions: In treating children with PNES, a multidisciplinary clinic has been effective in assisting families with the acceptance of the diagnosis and in educating patients to utilize appropriate coping skills to manage associated stressors, thus in turn significantly reducing PNES related ED visits and hospitalizations which leads to decreased unnecessary healthcare utilization. Such clinical experiences are important in today’s healthcare climate and will likely assist in cost containment.