Abstracts

Rationale: Individuals with a diagnosis of psychogenic nonepileptic seizures (PNES) are often high users of healthcare services, including emergency department visits, hospital admissions, and neurology visits. Research has been mixed regarding whether receipt of an accurate diagnosis reduces healthcare utilization, and thus reducing costs to the system and improving outcomes for the individual. In the current study, we hypothesized that the addition of brief neuropsychological intervention at the time of diagnosis will be associated with reduced healthcare utilization, as assessed by hospital visits, emergency department visits, and neurology visits. Methods: Participants (n = 90) included a subset of patients in the epilepsy monitoring unit (EMU) at a large regional hospital system in the south who experienced a typical seizure-like episode but did not have any epileptic correlate on EEG during the event. They were referred for a neuropsychology consult by an epilepsy attending and completed a brief neuropsychological intervention during the admission. This intervention included feedback that they had a (typical) seizure event that was captured on monitoring, explanation that these events were not epileptic in nature, and a review of history, including mental health history, history of trauma, and attitudes toward psychological intervention. Psychologists providing the intervention used supportive reframing and active listening techniques to respond to stated patient and family concerns and generally provided referrals for follow-up psychotherapy in the individual's hometown. Outcome measures included count data for emergency department visits, inpatient admissions, and number of neurology visits in the 6 months before and 6 months after the consult in EMU. Counts were analyzed using Excel. Results: Individuals were primarily female (76.7%) as identified by the electronic health record; primary ethnic designations included Caucasian (81.1%) and African-American (14.4%).In the 6 months following the brief intervention, 81.1% of patients had at least one less hospital admission than they had in the previous 6 months, with only 10% having the same number of visits and 8.9% having more visits. Regarding ED visits, most patients' visit counts stayed the same (88.9%), 7.8% had at least one less ED visit and 3.3% had at least one more visit in the 6 months following intervention. Neurology visits stayed the same mostly (52.2%), with 30% having at least one fewer visit and 17.8% having more visits. Conclusions: Our data suggests that even a brief intervention in the EMU is associated with fewer hospital admissions for patients with PNES. However, this study was limited by being a sample of convenience without a control group, and by limited information available in the electronic health records. Future studies will include control group with PNES who did not receive the intervention, evaluation of reasons for continued ED and neurology visits and estimated cost savings to the system. Funding: No funding