Abstracts

Rationale: The reported prevalence of anxiety disorders in persons with psychogenic nonepileptic seizures (PNES) varies significantly. Scales such as the Generalized Anxiety Disorder 7-item (GAD-7) scale mean to provide an overall assessment of the degree of anxiety reported by patients; these scales are largely subjective. For our study, we attempted to determine the prevalence of claustrophobia during MR imaging in persons with confirmed PNES. Typically this claustrophobia requires a treatment intervention in the form of administration of sedative medications for imaging. This may be a potential supplementary indicator of underlying anxiety, which may be useful in patients who report very low scores on their anxiety scales but have underlying anxiety that needs to be addressed.Methods: This was an observational, cross-sectional study involving retrospective chart review. PNES patients included all patients who had a confirmed diagnosis with video-EEG monitoring in our Epilepsy Monitoring Unit. Patients with a confirmed diagnosis of epilepsy were used as controls. Patients with significant cognitive delay were excluded. Each patient's electronic chart was reviewed to determine if that patient reported anxiety or claustrophobia on a standard pre-MRI radiology questionnaire and if premedication with benzodiazepines was required. Collected data was analyzed using Chi Square; Fisher's Exact test was used to compare each group's need for sedative medications to complete the brain MRI (due to a small number of epilepsy patients requiring sedation).Results: Thirty-three patients with PNES and 26 with epilepsy were included. 81% in PNES group and 69% in the epilepsy group were females (p=0.26). The average age was 39.1±12.44 in PNES group and 37.5±13.45 in the epilepsy group. 63% of PNES patients and 37% of epilepsy patients had a history of anxiety disorder (p=0.005). 79% of PNES patients and 34% of epilepsy patients had a diagnosis of depression (p=0.0006). There was no statistically significant difference between the PNES and epilepsy groups with respect to the chronic use of anxiolytic, antidepressant, or antipsychotic medications. Fifteen patient with PNES and 5 with epilepsy reported anxiety or claustrophobia on the pre-MRI questionnaire (p = 0.05). Eleven PNES patients and 1 in the epilepsy group required premedication with benzodiazepines, most often lorazepam (Fisher’s exact test, p = 0.008). Only one patient had coexistent epilepsy and PNES, and this patient required sedation.Conclusions: Patients with PNES are more likely to report claustrophobia and anxiety about having MRI scans, and they are more likely to be prescribed benzodiazepines to complete the study. This correlates with a higher prevalence of anxiety and depression in patients with PNES. The need for sedation for MR imaging studies may be a maker of underlying anxiety disorder in patients with PNES. A larger sample size of patients with coexistent PNES and epilepsy is needed to investigate these findings for this unique group of patients.