Abstracts

Rationale: This study aims to correlate patients' pre-diagnosis illness perception with clinical outcome three months after discharge from the epilepsy monitoring unit (EMU) at the Michael E. DeBakey VA Medical Center. Subjects were those diagnosed with psychogenic non-epileptic seizures (PNES) by video-EEG (VEEG) monitoring. The findings may help physicians identify earlier which patients may have difficulty accepting the diagnosis of PNES. Earlier identification of such illness perception may allow for a more tailored approach to managing the symptoms of these patients with the hope of improving their attack burden and quality of life. Methods: This was a prospective, longitudinal study following eight subjects diagnosed with PNES beginning with their admission to the EMU to three months post-discharge. Subjects completed the Broadbent Brief Illness Perception Questionnaire (BIPQ) prior to a standardized disclosure of their VEEG results. They were also asked to complete a symptom attribution question designed to uncover their perceived etiology of their attacks (psychological, physical, or a combination of both) - an instrument previously utilized to study patients with somatoform disorders (Mayor et al., 2012; Wessely & Powell, 1989). At three months, the investigators administered the same questionnaires to the patients via scripted telephone interview. An additional questionnaire regarding the current attack burden since discharge from the EMU was also given. Spearman's rank correlation coefficients were used to determine dependence between (a) patients' pre-diagnostic symptom attribution (5 point Likert scale) vs. (b) post-diagnosis attack frequency (5 point scale), attack intensity (5 point scale), and new mental health intervention (2 point scale) at three months after EMU discharge. Similar correlations were performed between (a) the first eight questions in the BIPQ (10 point scale for each question) and (b) post-diagnosis attack frequency and attack intensity at three months after EMU discharge. Results: There was a very strong correlation between those subjects who attributed psychological factors to the etiology of their attacks prior to diagnosis with improved frequency of PNES at three months post discharge (r_s = -0.92, p = 0.002). There was a strong correlation between the perceived negative impact on life (BIPQ question 1) with greater frequency of PNES at three months post-discharge (r_s = -0.84, p = 0.01). A 2-tailed t-test was conducted to compare each response from the BPIQ on admission and at three months, and there was no significant difference in the scores. Conclusions: Subjects who attributed greater psychological contributions to their attacks prior to the VEEG confirmation of PNES demonstrated improved attack frequency after discharge from the EMU. Patients who perceived their lives to be more negatively impacted by their attacks prior to diagnosis correlated with worse attack frequency after the diagnosis. While our sample size was small (n=8), our correlations (r_s) were robust across two psychometric instruments.