Abstracts

Rationale: 10% of patients with psychogenic non-epileptic seizures (PNES) have coexisting epileptic seizures (ES), although prevalence rates vary considerably among published reports and limited data is available on this group of patients. Distinguishing between PNES and ES can be challenging and there may be a tendency for clinicians to assume that once ES or PNES is diagnosed, that all other events in a particular patient are of the same type. If all events are incorrectly assumed to be ES, there is a delay in seeking appropriate psychological therapy for PNES, which can make PNES less likely to resolve and continues to unnecessarily expose patients to the iatrogenic risks of anti-epileptic drug (AED) therapy. If all events are incorrectly assumed to be PNES, there is a delay in the use of appropriate AED therapy and patients are exposed to the risks of uncontrolled ES, including sudden unexpected death in epilepsy.Methods: Retrospective review of clinical case notes for all patients known to have coexisting ES and PNES under the care of the Epilepsy Service at Cork University Hospital, Ireland. Patients were identified from the Epilepsy Service database. For each patient, we evaluated any difficulties during the diagnostic process, including emergency department attendance, outpatient clinic attendance, telephone contact with healthcare professionals, referrals for second opinions, changes in antiepileptic drug therapy, socioeconomic impacts, iatrogenic complications, patient role and patient recognition. Clinical outcome at most recent review was noted.Results: Fifteen patients were identified with confirmed coexisting ES and PNES. We describe the themes identified of delay in accurate diagnosis, increased healthcare resource use, misleading assumptions made by treating physicians and means by which a definite diagnosis was ultimately made.Conclusions: We highlight the challenges in establishing a diagnosis in a group of patients with coexisting ES and PNES. We describe the consequences of diagnostic delay in order to encourage clinicians to actively screen for features that should prompt further investigation, with the intention of improving quality of care for this patient group.