Abstracts

Rationale: Psychogenic Non-epileptic seizures (PNES) are classified by the DSM-IV as a conversion disorder. Patients with PNES compromise up to 24% of referrals to clinics for intractable epilepsy. [1] Estimates of the prevalence of PNES range from 5 to 20% in outpatient epilepsy populations [2,3] and from 10 to 40% of patients treated at epilepsy centers. [3] The outcome of PNES is generally poor. PNES resolves in less than 30% of patients following diagnosis [4]. Evidence on how best to manage and treat patients with this condition, however, is scarce. Methods: This longitudinal study included 73 patients evaluated for intractable epilepsy, at the South Texas Comprehensive Epilepsy Center (STCEC). All of the patients underwent continuous video EEG monitoring and were diagnoses as having PNES; 4 patients were excluded due to PNES along with epilepsy. After patients were identified they were asked to enroll in the PNES outcome study. Demographic variables were evaluated such as: age, gender, marital status, and living situation. Clinical variables such as: age at onset of PNES, age at diagnosis of PNES, psychiatric co-morbidities and clinical presentation of the PNES, were reviewed. Arrangements for Psychiatric follow up were also assessed. Results: Out of 73 patients identified as having PNES, 42 patients were Caucasians and 31 patients were Hispanics. Table 1 Forty-two percent (n=31) of patients were referred for mental health evaluation at discharged and only 15% (n=11) patients had in house psychiatric evaluation. Two to five years after diagnosis, six patients have been contacted. Although all of the patients had follow-up with psychiatry after diagnosis (and 60% received counseling), 100% still have PNES at follow-up, with 80% reporting reduced frequency of seizures. Sixty percent experience the same seizure presentation and continue to be seen by a neurologist. All remained unemployed and disable. All of the patients had a history of depression; three of six patients met criteria for current MDD; 60% met criteria for somatoform disorders Conclusions: In this cohort of patients we found that PNES in adults are refractory despite psychiatric intervention. This may due to lack of a multidisciplinary approach, coordinating psychiatric and neurological care. Further studies are necessary to determine better strategies to treat patients with PNES. References: 1.Sigurdardottir KR, Olafsson E. Incidence of psychogenic seizures in adults: a population based study in Iceland. Epilepsy 1998; 39:749-52. 2. Guberman A. Psychogenic pseudoseizures in non-epileptic patients. Can J Psychiatry 1982; 27:401-404 3. Krumholz A, Niedermeyer E. Psychogenic seizures: a clinical study with follow-up data. Neurology 1983; 33:498-5026.Szaflarski JP, Ficker DM, Cahill WT, Privitera MD. Four year incidence of psychogenic nonepileptic seizures in adults in Hamilton County, OH. Neurology 2000;55:1561-3. 4.Reuber M, Pukrop R, Bauer J, Helmstaedter C, Tessendorf N, Elger C. Outcome in Psychogenic Nonepileptic Seizures: 1 to 10-Year follow-up in 164 Patients. Ann Neurol 2003;53:305-311.