Authors :
Presenting Author: Amanda Dunlop, MSN, DNP, CNP, CNRN – OhioHealth
Rationale: The purpose of this project is to evaluate a QI initiative to improve outcomes of a Functional Seizure Program. Access to resources for psychotherapy was identified as a primary barrier by a multidisciplinary team. The intent of the Functional seizures program was to improve quality of life, improve symptoms, and reducing the number of seizure events for patients experiencing functional seizures.
Methods:
This project was approved by the OhioHealth IRB as a quality improvement initiative. Participants included patients diagnosed with Functional Seizures (formally Psychogenic Non-epileptic Seizures) over the age of 18. Participants Patients enrolled in the program met with an epilepsy trained CNP to confirm and reinforce the diagnosis, discuss evidence-based treatment recommendations, develop individualized planning for returning to activities such as work and driving, and medication management. Participants also met with the epilepsy social worker for education and referral to treatment resources for counseling. After meeting with a multidisciplinary team, including psychiatry and epileptology, resources were implemented to improve access to behavioral health by incorporating 2 social workers to specialize in treating functional neurological. Patients were offered counseling using multimodal therapy techniques that included concepts of cognitive behavioral therapy (CBT), mindfulness and EMDR (Reiter, Anderson, Reiter & LeFrance, 2015; LeFrance & Winze 2015). A pathway for referrals to psychiatry was established for management of psychotropic medications as needed. Data was collected post intervention and compared to preintervention data. Patients in both groups were evaluated at time of referral, 3 months and 1 year. Anxiety and depression scores were measured using the GAD-7 and PHQ9 at each visit. Patients were also assessed for subjective improvement of symptoms, seizure frequency, and ability to work and ability to drive. Demographic data, retention rates were also evaluated.
Results: During the study period 167 of 237 eligible participants (70.5%) completed the program. There were 88 participants in Group 1 (pre-intervention) and 79 participants in Group 2 (post-intervention). Demographics between the groups were similar with a mean age of 36, primarily female and primarily Caucasian Non-Hispanic. Patients in both groups reported improvement of seizures symptoms at 1 year and a reduction of seizure frequency. In Group 1 48% of participants and 41% in Group 2 reported > 3 months of seizure freedom at 1 year. Both groups reported improved anxiety and depression as measured by PHQ9 and GAD7. Both groups demonstrated a slight increase in employment and driving from the time of consult. Patients in Group 2 were more likely to engage in psychotherapy (75%) and psychiatry referrals (18%) as compared to the preintervention group (67% psychotherapy, 10% psychiatry).
Conclusions:
A multidisciplinary approach with psychiatry and neurology improves patient engagement in treatment for functional seizures.
Funding: This project was funded by the OhioHealth Corporation