Abstracts

Rationale: Rationale: Patients with non-epileptic seizures (NES) often experience acute psychosocial distress or chronic psychiatric symptoms, which result in inappropriate use of resources and poor health outcomes. Frequently, patients with NES do not understand or accept the diagnosis and recommended treatment. In order to address these issues, a multidisciplinary clinic, the Integrative Epilepsy Clinic (IEC) at Children's Hospital Colorado (CHCO), was created for patients with a confirmed diagnosis of NES and other complex neuropsychiatric and developmental disorders.Methods: Methods: Providers include a nurse practitioner, an epileptologist, a clinical psychologist, and a neuropsychologist. Patients are referred by a primary neurologist or epileptologist. We provide assessment of psychiatric symptoms and neuropsychological functioning, focusing on depression, anxiety, trauma, quality of life, and cognitive functioning. Extensive psychoeducation is provided for patients with NES and their families. Referrals are made to external resources that address psychiatric and social factors. Systematic collection of patient outcome data (e.g., psychiatric symptoms, treatment adherence, ED utilization, phone calls) will enable us to evaluate the multidisciplinary clinic process.Results: Results: The IEC’s goal is provision of more effective interventions, including cost, for patients with NES and other complex neuropsychiatric and neurodevelopmental disorders. Principle barriers to achieving our goals are effective utilization of provider’s time (scheduling) and financial (billing for professional time). Outcomes data are being collected to document more effective use of resources and improved quality of life, justifying cost and resource utilization.Conclusions: Conclusion: We have developed IEC to address use of resources by patients with NES. Challenges include poor understanding of diagnosis by patients and their families, inconsistent approaches to diagnosis, poorly understood and accepted treatment approaches and lack of access to mental health facilities. Lessons learned in establishing the IEC provide a blueprint for other institutions. We hope to learn effective ways to present a NES diagnosis, improve follow-through with appropriate psychiatric treatments, reduce the frequency of symptoms, improve quality of life, and reduce the frequency of hospitalizations and ED visits for NES.