Abstracts

Rationale: It is well described that psychogenic non-epileptic seizures (PNES) and epileptic seizures (ES) may co-exist in the same patient, but how to best define this co-existence and its incidence are debated. Methods: We reviewed all epilepsy monitoring patients at the University of Maryland Medical Center over an 18 month period to assess the incidence of both PNES and ES co-existing in the same patient as documented by capturing both PNES and ES during the same admission. Patients who had more than one admission were counted only once. Patients who were characterized in our database as having both PNES and ES were identified and those cases were reviewed. Results: Of our 256 total epilepsy monitoring patients, 167 (65%) were female, and the mean age was 41 years (range 16-88, standard deviation 14.7). Of the total patients, 70 (27%) had documented PNES during their admission, and 11 (15.7%) of these PNES patients had co-existing epileptic seizures determined by video EEG during that same admission. Conclusions: The percentage of co-existing PNES and ES captured on video EEG monitoring in our patients (15.7% of all PNES patients) was higher than expected, and may relate in part to more aggressive seizure medication tapers to provoke events, thereby unmasking more epileptic seizures in our patients. In addition, embellished auras mimicking PNES cannot absolutely be ruled out in a small number of cases. Still, the incidence of co-existing PNES and ES in such a high percentage of patients is notable and suggests that caution is warranted when tapering medication in some patients with PNES.