Abstracts

Rationale: Psychogenic non epileptic events (PNEE) are paroxysmal changes in behavior that resemble an epileptic seizure but have no electrographic correlate and are instead caused by psychological factors.  Clinical management of PNEE can be challenging and requires an integrated care approach with both neurology and mental health providers to achieve optimal outcomes.  Coordination of care by nurses and/or social workers has been recommended as one strategy to help integrate the care of these patients and improve their outcomes.  Long term outcomes in pediatric patients with PNEE are not fully understood.     Methods: A clinic in which patients are seen by both a neurology provider and a psychologist has been in place at Nationwide Children’s Hospital for 6 years. A nurse and social worker were added to the PNEE clinic in January 2018 to help with care coordination for children and adolescents with PNEE who are seen in the clinic. The social worker and nurse screen for barriers to the patient attending the appointment and call to remind them of their appointment. The nurse makes follow up phone calls at 1 month, 3 months and 1 year following their appointment. The calls are made to identify if PNEE are still occurring, acceptance of the diagnosis, if the patients have returned to school, are receiving mental health services, and provide further counseling or interventions if needed.  Data pertaining to patients who were scheduled to be seen in the PNEE clinic between January 1 and May 16, 2018 (Group #2) were entered in a database and data collected at the time of the appointment, 1 month, and 3 months phone calls.  Data regarding show rates as well as emergency department (ED) visits after the clinic appointment for patients scheduled from July 1 through December 31, 2017 (Group #1) was obtained by chart review as historical controls. An independent t-test was used for comparing the groups. Results: Group 1 had an 85% show rate for their PNEE clinic appointment compared to a show rate of 89% for Group 2 (p=0.85).  Of the 29 patients from Group 1 who attended their appointment there were 6 ED visits after their appointment (21%) compared to 2 ED visits in the 32 patients from Group 2 (6%) (p=0.02).  Of the 18 patients in Group 2 who were reached at 1 month, 11 were accepting (61%), 4 not accepting (22%) and 3 were questioning the diagnosis (17%); all but one were in counseling (94%). Conclusions: Implementation of care coordination by a nurse and social worker as part of a multidisciplinary team decreased ED visits for children and adolescents with PNEE and may improve attendance at PNEE clinic appointments. Although there is no historical comparison for our cohort, with the current model, 61% patients accepted the diagnosis and 94% were successfully linked with counseling at 1 month following the clinic visit. Prior reports have emphasized that early acceptance of the diagnosis leads to improved outcomes. Funding: None