Abstracts

Rationale: After the diagnosis of psychogenic non-epileptic events (PNEE) in the epilepsy monitoring unit (EMU), many patients continue to experience significant emotional exasperation from their attacks, and return visits to the emergency room (ER) are not uncommon. Formal psychotherapies and support programs dedicated to PNEE frequently demand significant dedication from both the patients and providers. Here, we aim to evaluate a novel intervention, initiated by the treating neurologist, with the primary goal of effecting measurable changes in the quality of life of patients with PNEE. Methods: Patients were randomized to the control or treatment groups after video-EEG (VEEG) confirmation of PNEE at the EMU of Michael E. DeBakey VA Medical Center, Houston, Texas. Both groups received the standard of care disclosure/explanation of their diagnosis, and then completed a pre-discharge questionnaire. The control group completed a post-discharge questionnaire during a standard follow-up clinic visit after 3 months. The treatment group underwent 3 successive monthly therapy sessions led by a nurse practitioner. The first session entailed a psycho-educational seminar dedicated to enhancing the understanding of PNEE. Two subsequent support group sessions focused on specific coping strategies. Group members were encouraged to openly share their experiences. After the third therapy session, patients were given a post-discharge questionnaire analogous to the control group's post-discharge questionnaire. All patients who were unable to successfully complete the follow-up questionnaire were excluded from analysis. Comparisons were then made between the control and treatment groups using the Student's T-test and the Chi-Squared Test as appropriate. Results: Out of 35 patients randomized into our study, 16 patients were assigned to the control group and 19 patients were assigned to the treatment group. After excluding those lost to follow-up, statistical analysis was performed on 9 control and 14 treatment group patients. Patients who completed the prescribed intervention showed significantly more affirmative endorsement of the following statements: "My attacks do not really bother me or affect my life that much anymore" (p<.001), and "I have some control over my attacks" (p=0.003). In addition, patients in the treatment group had a significantly lower post-EMU discharge visit rate to the ER (7.14% vs 22.22% in treatment and control group, respectively, p=0.018). Conclusions: We show that among patients with VEEG confirmed PNEE, a novel abbreviated and neurologist-initiated support group program can be effective in improving the quality of life of patients with PNEE. These improvements were further supported by the observation of a significantly reduced ER visit rate in the treatment group. Future studies with greater sample size and longer follow-up can help determine the long-term efficacy of this intervention.