Abstracts

Rationale: Psychogenic non-epileptic seizures (PNES) are a common problem that occurs in 10%-58% of adult referred to an epilepsy center. Despite the prevalence of this condition little is known of its variability with age, which may have important diagnostic and therapeutic implications. In this poster we target middle age and describe 14 such patients admitted to our Epilepsy Monitoring Unit (EMU) confirmed to have PNES. Methods: Patients (N=14) with long term medically refractory seizure-like episodes (>5 years) were admitted to the EMU for definitive diagnosis. Age ranges were 40-55; 4 males and 10 female; 8 married with strong family support, 5 single, 1 separated and in the process for divorce. While on the EMU, patients were given a battery of neuropsychological testes, including cognitive, personality (MBMD, and psychiatric (BDI-II and SAST). In addition, post-EMU records from neurology and psychiatry or psychology were reviewed. Results: Results of the EMU study, EEG and imaging studies for all patients were negative. All patients, therefore, had PNES. All had psychiatric disorders of depression, anxiety or both, diagnosed by psychiatric interview. All took psychotropic medicines. All had history of mental or physical abuse. Most of them took more than one antiepileptic medicines. Several patients experienced an aura: 1 tasted alcohol; 1 felt dissociated; 2 had numbness in their bodies; and 1 diplopia. All were alert immediately after the attacks. Several characteristics were noted in this cohort: (1) seven were demonstrably emotional, crying during the event;(2) in 10 patients, the extremity movements during the ictal event were low amplitude (in 2 patients, relative high amplitude). (3) No pelvic forward thrusting activity was seen. (4) Most of events occurred at night when the patients were sleeping in shallow sleep (stage I or II). Psychometrically, the middle age patients showed considerable depression, frontal lobe deficits but less disinheriting, and less need to dissimulate. Personality profile suggested that patients had varied personality patterns but had problems with treatment prognostics and stress moderators. Finally, treatment after the EMU experience with neurological and mental health professionals resulted in less attacks. Antiepileptic medicines didn't really help PNES patients. Most of them stopped antiepileptic medicines after EMU study. A few PNES patients still continued to take antiepileptic medicines, but it was single and low dose for migraine headache prophylaxis. Conclusions: While many standard PNES symptoms were noted, different clinical manifestations in the middle aged population can be significant. We saw a higher degree of significant emotional expression, less pelvic thrusting, and low amplitude jerking or shaking movements, and common events in shallow sleep. Psychological measures were also different, especially as regarding executive function with less disinhibition. Further prospective study is warranted with appropriate controls.