Abstracts

Rationale: Non-epileptic attacks are common and account for 20-25% of all intractable seizure disorders referred to epilepsy centers. Most are found lacking organic cause and are presumed psychogenic in origin. Non-epileptic attacks are frequently suspected at a single clinical encounter, but the diagnosis is usually only made with certainty following prolonged video-EEG telemetry recording. Similar to epilepsy, these patients are disabled by their paroxysms, and they frequent Emergency Departments without clear diagnoses. The burden to both patients and the health care system is therefore considerable. This study aims to determine whether the diagnosis of non-epileptic seizures on video-EEG telemetry is effective in reducing the utilization of acute care health resources. Methods: All patients undergoing EEG telemetry and discharged between January 1st 2002 and December 31st 2007 with a diagnosis of non-epileptic seizures were included in the study. The province-wide electronic health care record was used to establish patients Emergency Department (ED) visits. Patients who had no history of ED visits either during the 24 months prior to, or the 24 months following the date of diagnosis were excluded from the study. Results: Twenty-one cases were identified, 67% female, with mean age 44.4 years of age, and 19% had co-existent epilepsy. Average duration of EEG was 8.1 days and 6.1 non-epileptic events were recorded. ED visits were reduced during the 24 months following (3.73 /- 3.78; mean /- SD) compared to the 24 months preceding (5.55 /-5.94) the diagnosis (p<0.1, Wilcoxon signed rank test). There was no difference in the number of psychiatric visits to the ED following the diagnostic admission. Conclusions: The diagnosis of non-epileptic seizures by video-EEG telemetry is associated with a reduced rate of ED visitation during the two years following hospital admission. These findings suggest that telemetry not only helps relieve diagnostic uncertainties for the patient and physician, but also has quantifiable benefits for an over-extended and costly area of health care utilization.