Abstracts

Rationale: A principle purpose of an Epilepsy Monitoring Unit (EMU) is to differentiate epileptic and non-epileptic events. In our EMU, all patients who are diagnosed with pseudoseizures (psychogenic non-epileptic seizures/PNES) receive the standard of care treatment and therapy including a lengthy discussion of the diagnosis and, typically, a psychiatric consultation if the patient does not already have intense psychiatric follow up. Even when patients receive the diagnosis of pseudoseizures confirmed by video EEG, these patients are often re-monitored. This study aims to categorize the reasons for EMU readmissions in patients with PNES. Methods: A retrospective chart review of EMU admissions at Albany Medical Center from 2012 to 2015 was performed to evaluate PNES readmissions in patients 18 years of age and older. We identified patients that had recurrent EMU visits after an initial diagnosis of PNES by video EEG. These patients were separated into those with PNES-only spells and those with both PNES and epileptic seizures (PNES/ES). The requests for repeat admissions were categorized as follows: characterization of a known spell type not captured during the first monitoring, characterization of a new spell type, or re-characterization of the same spell type. Results: During the time period above, there were 1390 separate EMU visits comprised of 1162 individuals. Of these, there were 8 patients with PNES-only or PNES-ES who were re-monitored. 6 of the 8 had PNES-only and 2 of the 8 had PNES/ES. Of the PNES-only patients, 3 were re-monitored to characterize a different spell type, 2 had events that were not caught during the first visit as they elected to leave early, and 1 was re-monitored to characterize the same spell type. Of the patients with PNES/ES, one was re-monitored several times to characterize both different spells and events not caught while the other was to characterize a new spell type. Regarding management, 5 of the 6 PNES-only patients had a change in management after a second EMU stay. 4 patients had complete discontinuation of their anti-epileptic drugs (AEDs) and 1 patient continued to receive some AED for mood regulation. Repeat PNES-only patients were continuing to receive AEDs either because prior monitoring did not characterize all spell types, or they were restarted between monitoring periods due to a new spell type. One, however, returned to the EMU on AEDs despite a PNES-only diagnosis during the first monitoring due to provider mismanagement. Conclusions: Patients appropriately diagnosed and treated for PNES in an EMU are occasionally re-monitored. The single most common reason is relatively unavoidable, to characterize a new spell type. The next most common reason would be to characterize a known spell type not captured during the first admission. There are varied reasons for a patient leaving early, usually due to patient preference, however, trying to keep patients in the EMU longer to complete their workup may be more efficient in the long run as this typically changes management. The last reason, and fortunately the least common in our EMU, was due to inadequate treatment after the diagnosis was made requiring re-affirmation of the diagnosis and appropriate mental health treatment. Some may see readmission to an EMU as a redundant exercise, and perhaps some changes can be made during the first monitoring to reduce the need for this. However, this study shows that re-monitoring is often an unavoidable, treatment changing procedure that does directly impact patient care. Further larger studies evaluating EMU stays in PNES patients should be considered to expand upon these early findings to guide appropriate, cost effective use of EMU stays in the future. Funding: None