Abstracts

Rationale: Psychogenic non-epileptic seizures (PNES) are typically diagnosed in long-term video EEG monitoring (LTVM) units. The practice of delivering the diagnosis and arranging follow-up for PNES varies among LTVM units and no standard treatment approach exists. The contribution of an inpatient psychiatry consultation also varies across centers, and patients who do not understand their diagnosis often return to emergency departments or seek second opinions, incurring high healthcare costs. We compared event frequency and behavioral outcomes following three different treatment approaches with the goal of identifying the best treatment option and developing a standardized approach to PNES following diagnosis. Methods: Patients admitted to the LTVM unit for diagnostic evaluation of spells of unclear etiology at Emory University Hospital from July 2011 to May 2012 were consented for the study. All subjects completed a baseline questionnaire as well as the Beck Depression Index (BDI) and Quality of Life in Epilepsy-10 (QOLIE-10) scale. Patients diagnosed with PNES by video EEG were randomized to one of three treatment groups: Group A received an unscripted diagnosis delivered by the epilepsy attending and no further management; Group B received a scripted discussion of the diagnosis, a formal psychiatry consultation, and an educational handout; and Group C underwent the same treatment as Group B but also received weekly phone follow-up. All groups were called at 8 weeks to determine event frequency, BDI and QOLIE-10 score. Results: A total of 75 patients were consented for the study of which 30 were randomized and completed follow-up with the following distribution: Group A= 10, Group B=9, Group C=11. There were no significant differences in baseline characteristics among the groups (Table 1). There was a significant decrease in event frequency at 8 week follow-up for patients in Group B and C (p=0.011, 0.004, respectively) (Table 2). QOLIE 10 scores improved in all patient groups, particularly in group B and C (p= 0.05, 0.001, 0.001). Patients in Group B and C also endorsed fewer social and work limitations and were less afraid of having further events. There was a significant decline in BDI score seen in group C only (p=0.004). Although not statistically significant, Group C was also more likely to seek follow-up from a mental health provider and believe their events would stop, while they were less likely to seek a second opinion. Conclusions: A defined PNES treatment strategy that includes inpatient psychiatry consultation, scripted discussion of the diagnosis, and weekly phone contact may impact event frequency, quality of life, depression, and appropriate healthcare utilization. Further studies evaluating PNES treatment algorithms are warranted.