Abstracts

Psychogenic non-epileptic seizures (PS) are a common, often disabling condition, frequently confused with epilepsy, and usually treated with antiepileptic drugs (AEDs) prior to diagnosis. The gold standard for diagnosing PS is inpatient video-EEG monitoring, where PS represent 20-50% of discharge diagnoses. There can be no effective intervention for PS without first establishing the diagnosis.
The past decade has seen extensive efforts to educate medical students, primary care givers and neurologists about PS, emphasizing early referral in order to prevent the social and medical morbidity of this potentially treatable condition. To assess the effects of this effort we reviewed records from two cohorts of proven PS patients, one from 1989-1993 and the other from 2003-2005., Since 1989, our inpatient video-EEG monitoring unit has maintained a database of all admissions and discharge diagnosis. A series of 46 consecutive patients with PS was selected, beginning with January 1989. The diagnosis required at least two typical spells with either alteration of consciousness and/or bilateral motor activity and no EEG changes, absence of epileptic seizures, and team consensus. A second cohort of 46 consecutive PS patients was selected beginning with admissions from January 2003, using identical criteria. All records were abstracted for age, sex, number of years between onset of the currently active PS and admission for video-EEG, number of AEDs at the time of admission, and other features., The two cohorts did not significantly differ with regard to age, or proportion of women. The median delay between onset of PS and diagnostic admission was 5.0 years for the 1989 cohort and 2.3 years for the 2003 cohort (P[lt]0.01; Wilcoxon test). For the 1989 cohort, 80% of patients were on AEDs at the time of admission and 24% were on 2 or more AEDs. Results for the 2003 cohort were nearly identical (mean of 1.2 AEDs at admission for each group; NS)., Our results show that patients with PS are now being referred for diagnostic evaluation much earlier than was the case 12 years earlier. During this time period there were no changes in the availability of inpatient monitoring in Oregon. Therefore, a likely explanation is the impact of efforts, local and national (AES), to educate students and physicians about PS. Despite progress, two years remains a considerable lag between onset of PS and diagnostic referral, and there has been no reduction in the use of AEDs to treat PS prior to diagnosis.,