Abstracts

Rationale: PNES treatment is psychological, primarily with Cognitive Behavioral Therapy (CBT). The Parkland PNES clinic was created to treat these unique patients,with a team of psychologists, psychiatrists, and social workers. We evaluate healthcare utilization among patients who attended PNES clinic hypothesizing that attending PNES clinic would decrease healthcare utilization for seizures and all causes.

Methods: This was a retrospective chart review of patients who had been discharged from Parkland EMU between January 1, 2016 and December 31, 2018 with follow-up until December 31, 2023. Exclusionary criteria included patients with comorbid epilepsy/on anti-seizure drugs for seizure-related causes; patients not given a referral due to distance; and patients found to have other causes for PNES-like episode (e.g. movement disorder). We obtained data regarding demographics, social history, and treatment interventions. Our outcome variables were both all-cause and seizure-related healthcare contacts either 1 year from EMU discharge date (for those who did not attend any PNES clinic sessions) or 1 year from last PNES clinic session attended.

Results: A total of 302 patients was initially collected. Of these, only 31 patients had attended any PNES clinic sessions. We were unable to match control the group by age/sex, so a random number generator was utilized to select 31 patients who had not gone to any PNES clinic visits, for a grand total of 62 patients that were subsequently analyzed. A demographics analysis was done, which showed there was no significant difference due to age, sex, race, insurance type, or English proficiency when it came to those who went to PNES clinic vs those who did not. The percentage of healthcare contact was not significantly different between both groups (PNES group clinic attendees: 29% with seizure-related concerns, 71% with non-seizure related concerns; PNES non-attendees: 26% with seizure-related concerns, 74% with non-seizure related concerns; P=0.78). Similarly, of those who went to PNES clinic, there was no significant difference due to age, sex, race, insurance type, or English proficiency when it came to those who went to more than 4 sessions than those who did not. Within those who went to PNES clinic, the percentage of healthcare contact was not significantly different between those who went to >4 sessions vs those who did not ( >4 sessions: 23% with seizure-related concerns, 77% with non-seizure concerns; < =4 sessions: 33% with seizure-related concerns, 67% with non-seizure concerns; P=0.70)

Conclusions: While the sample size was low, preliminary data from this group does not show a significant difference in healthcare utilization between those who attended PNES clinic vs those who did not. Additionally, among those who attended PNES clinic, there was no significant difference in healthcare utilization between those who attended over half of the sessions vs those who did not.

Funding: none