Abstracts

Rationale: Up to 30% of adult patients presenting with seizure-like episodes are found to have psychogenic non-epileptic seizures (PNES). A review of video footage of patients in a seizure monitoring unit concluded that the presence of a toy stuffed animal, sometimes referred to as a teddy bear sign , could help identify patients with PNES (Burneo et al., Neurology 61:714-715, 2003), but the usefulness of this sign has been questioned (Hoerth et al., The Neurologist 14:266-270, 2008). We were not certain that the suggested correlation was present in patients in our Epilepsy Monitoring Unit (EMU), and therefore reinvestigated this. Methods: We studied all patients admitted to the EMU at the Johns Hopkins Hospital during a 12 month period for the presence or absence of a stuffed animal. We de-identified patients according to requirements of the Johns Hopkins Institutional Review Board and recorded age, gender, seizure diagnosis, and presence or absence of mental retardation. We excluded patients under the age of 15 years, with mental retardation, with diagnoses other than epilepsy or PNES (syncope, sleep disturbance, no events recorded, etc.), or with both epilepsy and PNES. Results: During a 12-month period, 302 patients were admitted to the EMU and 226 were over 14 years of age. Final diagnoses were epileptic seizures (n = 108), non-epileptic seizures (n = 76), epilepsy and PNES (n = 6), other events (n = 32), and epilepsy with mental retardation (n = 4). Therefore, 184 patients (127 women and 57 men) were studied. Twenty-seven (15%) of these patients brought toy stuffed animals to the epilepsy monitoring unit. Nine patients (7 women) with stuffed animals were diagnosed with PNES and eighteen (14 women) were diagnosed with epileptic seizures (p = 0.4042, two-tailed Fisher s Exact Test). Conclusions: In this study, the percentage of patients over 14 years of age with stuffed animals in the EMU did not significantly differ between those with epilepsy and those with PNES. In fact, there were more epilepsy patients than PNES patients with stuffed animals. There was an increased percentage of women with stuffed animals. This most likely reflects social norms.