Abstracts

Rationale: Psychogenic nonepileptic events (PNEE) are events that look like epileptic seizures but are not caused by abnormal electrical activity in the brain, rather are psychological in origin. Prior studies have shown that early acceptance of the diagnosis is critical to achieving remission. We aimed to evaluate the impact of capturing events with an EEG on acceptance of the diagnosis. Methods: All patients referred to the PNEE clinic at Nationwide Children’s Hospital from January 1, 2018 – December 31, 2018 were prospectively entered into a database and the presence of confirmatory testing on EEG was recorded. Patients were contacted by phone at one and three months following the PNEE appointment, regardless of show to clinic, and asked about their acceptance of the diagnosis and clinical status. Differences between acceptance and remission/improvement for patients who had their diagnosis confirmed on EEG were compared to those who had not utilized the Phi coefficient. Families who were questioning the diagnosis were excluded from the comparison. Results: The PNEE clinic received 98 new patient referrals in 2018. Ninety-two patients were scheduled to be seen in the PNEE clinic with an 86% show rate. Forty-four (45%) patients had confirmation of the diagnosis on an EEG and 48 (49%) did not. Show rates to clinic were similar and high for both groups. Three patients were ultimately diagnosed with epilepsy and one with likely epilepsy. Thirty-three patients at one month and 43 patients at three months were unable to be reached for follow up. There were eight patients who we were unable to be reached at one month, but who were successfully contacted at three months and who had all accepted the diagnosis. At one month follow up, 19 (43%) of patients with an EEG confirmed diagnosis accepted the diagnosis and 27 (61%) were in remission or improved. This is compared to 11 (23%) of patients in whom the diagnosis was made clinically, without EEG confirmation, had accepted the diagnosis and 19 (40%) were in remission or improving. At the three-month follow up, 18 (41%) of patients with an EEG confirmed diagnosis accepted the diagnosis and 20 (45%) were in remission or improved; 5 (11%) had not accepted the diagnosis. Likewise, 18 (38%) of patients in whom the diagnosis was made clinically without an EEG confirmation had accepted the diagnosis and 19 (40%) were in remission or improving. Conclusions: A statistically significant greater acceptance of the diagnosis and a trend towards greater numbers of patients improving or in remission is seen in patients who had confirmatory testing with capturing events on an EEG at one-month follow up; however, these differences become less apparent at the three-month follow up. There is substantial attrition at the one- and three-month time points, limiting the interpretation of these results. More data with improved follow up is needed. Funding: No funding