Abstracts

Rationale: People with psychogenic non epileptic seizures (PNES), much like those with epileptic seizures (ES), often present in the emergency room (ER). The recognition and management of PNES in the ER is often problematic. Emergency medical technicians (EMTs) and Emergency Medicine physicians (ERMDs) are usually the first responders and make decisions about initial management. We sought to determine whether these professionals think about the possibility of PNES, have had any training in PNES, and to understand their approach in managing these patients when confronted with patients with acute paroxysmal abnormal behaviors. Methods: Short questionnaire about PNES and ES were designed and distributed to EMTs and ERMDs (PGY 2 and up) in three busy ERs in New York City. IRB approval was obtained. Questionnaires (anonymous) were collected and descriptive results were tabulated. 43 ERMDs and 105 EMTs responded. Results: EMTs 35% hand never heard of the diagnosis of PNES. 55% had no formal training about PNES. Of those with PNES training, nearly 50% had learned about it through lectures and their own reading. 83% believed depression /anxiety was a co- condition, while only 13% thought that fibromyalgia was a co-condition. 22% were unsure if they had unknowingly intubated a patient who might have had PNES. ERMDs 20% had not heard of PNES. 70% had never had formal training about PNES. 28% used IV benzodiazipines to treat PNES in the ER. 56% agreed that Neurologits were best qualified to diagnose PNES, but only 30% would seek Neurological consultation in the ER. 21% believed that malingering was the most common DSM-IV-TR diagnosis in PNES. Less than 50% believed that gradual onset of symptoms was common in PNES. Conclusions: Despite being the first responders, EMTs and ERMDs had a large knowledge gap in the recognition and understanding regarding PNES. While PNES is a difficult diagnosis to confirm in the ER, it is nonetheless important to consider and recognize, in order to prevent over treatment, and to properly triage these patients for appropriate care. Neurologists need to work with EMT and ERMD specialties to raise awareness and education level with regard to PNES.