Abstracts

The incidence of psychogenic nonepileptic seizures (PNES) varies with demographic, psychological and clinical history variables (i.e. gender, MMPI profiles, age of seizure onset, etc). Medication use may also differ; PNES patients generally take fewer AEDS than patients with epileptic seizures (ES). Few studies have explored the utilization of other medications within these two populations. This study evaluated the types of medications used by patients with PNES and ES., Hospital records of a consecutive series of adult patients who completed video-EEG monitoring and were diagnosed with ES (N=178) or PNES (N=170) were prospectively reviewed. Patients with both pseudoseizure and an epilepsy diagnosis were excluded. Medication variables examined include: the type and number of different prescribed medications, including current AEDs, previously tried AEDs, medications for psychiatric symptoms (typical and atypical SSRI, tricyclics, anti-psychotics, anxiolytics), pain medications (both narcotic and non-narcotic), and others., PNES patients were on nearly twice as many total medications at the time of admission ([italic]M[/italic]=6.0)[italic] [/italic]than ES patients ([italic]M[/italic]=3.2, [italic]p[/italic][lt].01). PNES patients were more likely to be taking psychiatric medications, anti-hypertensives, inhalers, gastric-reflux medications, and analgesics(all [italic]p[/italic][lt]0.01). Nearly half of the PNES group took analgesics (46%) compared to only 11% of patients with ES ( [italic]p[/italic][lt]0.01). Narcotic pain medication use was common in the PNES (32%) population but rare in the ES group (3.4%, [italic]p[/italic][lt]0.01). Patients with epilepsy were currently taking more AEDS and were tried on more in the past than PNES patients([italic]p[/italic][lt]0.01). However, the duration of illness was longer in the ES group ([italic]p[/italic][lt]0.01). When the total number of AEDS tried was divided by the duration of the disorder, PNES patients tried more AEDS per unit of time than ES patients ([italic]p[/italic][lt]0.05). 28% of all PNES patients took benzodiazepines compared to only 7% of ES patients ([italic]p[/italic][lt].01). Benzodiazapine monotherapy for [ldquo]seizures[rdquo] was reported exclusively in the PNES group ([italic]p[/italic][lt]0.01)., Our findings demonstrate increased utilization of a variety of different medications by patients with PNES as compared to ES. The increased medication usage might reflect increased physician utilization, drug intolerance by psychogenic patients, and other markers of somatization. PNES patients were not only taking more AEDS per duration of their [ldquo]epilepsy[rdquo], but also more commonly use benzodiazepines as monotherapy. The increased benzodiazepine usage among PNES patients could reflect physicians[apos] attempts to treat both psychiatric symptoms such as anxiety and presumed epilepsy. In combination with other clinic data, the medication profiles may provide clues about the likelihood of diagnosing PNES or ES.,