Abstracts

Rationale: There is a recognized associations between most substance use disorders and independent mood and anxiety disorders. This relationship has been well documented in a range of population-based studies. The objective of this study is to systematically analyze the relationship between recreational drug use (alcohol, cannabinoids, heroin, cocaine, ecstasy, amphetamines and LSD) and psychiatric comorbidity in patients with epileptic and non-epileptic seizures. We attempted to establish associations between different psychiatric comorbidities and recreational drugs use in psycogenic non-epileptic seizures (PNES). Methods: We conducted a double cohort retrospective study comparing patients with epileptic and psycogenic non-epileptic seizures. We reviewed 166 charts of patients admitted to epilepsy monitoring unit (EMU) from July 2010 to July 2012 at the epilepsy center at the Cleveland Clnic Florida. Then, compared the following variables in these 2 different cohorts (Epileptic vs PNES): gender, age, psychiatric comorbidities including anxiety, depression, bipolar disorder, alcoholism, generalized anxiety disorder, obsessive compulsive disorder, and schizophrenia. Finally, we also reviewed if the drug screen was positive on admission or if the patient admitted to illicit drug use as part of the admission history. Results: The study population was composed of 166 patients: 40 (24%) patients with PNES and 126 (76%) with epileptic seizures. The mean age was 44 (SD=15.1) in the PNES and 43 (SD=15.8) in the epileptic patients. There were 27 (67.5 %) females in the PNES group and 84 (66.7%) in the epileptic group. The most frequent psychiatric comorbidity found in both group of patients was depression, 27.5% (n=11) in PNES group and 8.7% (n=11) in the epileptic cohort. Anxiety was found in 15% (n=6) in the PNES group and 2.4% (n=3) in the epileptic patients. We found a significant association between psychiatric comorbidities and PNES (OR:5.46; CI:2.5-11.7). Depression (OR: 3.96; CI:1,6-10.5) and anxiety (OR: 7.23; CI:1.7-30.4) were significantly associated with PNES as well. Regarding recreational drug use, 22.5% (n=9) and 23.8% (n=30) were found to use recreational drugs in the PNES vs epileptic group respectively. There was no significant association between recreational drug use and PNES ( 2(1) = 0.03, p=0.86).Conclusions: In the present study, we found that the proportion of psychiatric comorbidities is much higher in patients with PNES than in patients with epileptic seizures. We also did not find a significant association between recreational drug use and PNES. The prevalence of illicit drug use was found to be higher in patients with PNES and epileptic seizures when compared with the general population. Finally, given the high prevalence of illicit drug use and psychiatric comorbitities, our findings support the important role of the psychiatric evaluation and treatment of these conditions in patients with epilepsy and PNES.