Abstracts

RATIONALE: Although video-EEG monitoring has proven to dramatically increase the ability of clinical epileptologists to correctly diagnose inidividuals with nonepileptic seizures, prognosis and therapy for such patients have not been as well studied and remain controversial. We analyzed a large group of patients with well-documented nonepileptic seizures to determine factors useful for predicting long-term prognosis and guiding management.
At the end of this activity the participants whould be able to discuss factors that predict outcome and prognosis in indivividuals with nonepileptic seizures.
METHODS: We reviewed all epilepsy monitoring unit admissions to the University of Maryland Epilepsy Center from 1989 to 1995. All patients with video-EEG documented nonepileptic seizures were identified and characterized in terms of age; sex; seizure duration, type, and frequency; associated psychopathology; and outcomes. In particular, outcomes were determined at follow-up of 1 year or more. Outcomes were graded as [dsquote]excellent[dsquote], [dsquote]good[dsquote], [dsquote]fair[dsquote], and [dsquote]poor[dsquote] based on cessation of seizures and function measures. Patient and seizure characteristics were correlated with outcome using contingency analysis ([dsquote]p[dsquote] less than or equal to 0.05).
RESULTS: A total of 568 patients were monitored from 1989 to 1995. Of these 150 individuals (18%) were confirmed to have nonepileptic seizures by video-EEG monitoring. Among these 150 patients with nonepileptic seizures, 80 (53%) could be adequately characterized, had no evidence of active co-existing true epileptic seizures and had more tham 1year of follow-up.
Significant predictors of outcomes included: age (individuals under the age of 18 had the best outcomes); nature of nonepileptic seizures (individuals with nonconvulsive events were more likely to become event-free [excellent outcome], while individuals with convulsive manifestations were more likely to have poor outcomes); duration of nonepileptic seizure disorder (patients with seizures for 3 months or less had the best prognosis, and those with events for less than 1 year still had better prognoses that those with nonepileptic seizures going on longer prior to diagnosis); and the severity and nature of associated psycholopathology (patients classified with more severe psychiatric disorders such as somatization disorders, personality disorders, or major affective disorders had poorer outcomes than individuals judged to have less severe psychopathology including anxiety, stress, or coping disorders, and misinterpretation or elaboration of physiologic events).
CONCLUSIONS: Our findings demonstrate factors that predict or influence outcome and prognosis in patients with nonepileptic seizures. These include the age of the patient, duration of the nonepileptic seizure disorder prior to correct diagnosis, nature of the events, and associated psychopathology. Early diagnosis is confirmed to be important in outcome. In particular, nonepileptic seizure patients diagnosed within 1year of onset have a better prognosis that those diagnosed later, and individuals diagnosed under the age of 18 years have better outcomes than older subjects. In addition, because associated psychopathology significantly influences outcomes, it also warrants further study and attention to develop better strategies for improving the prognosis for patients with nonepileptic seizures.
[Supported by: A grant from the Rosen Foundation]