Abstracts

Rationale: Paroxysmal Non-Epileptic Spells (PNES) can mimic true epileptic seizures. The key to diagnosis is a good history and a proper neurological examination, with gold standard being video EEG monitoring. Ictal arrhythmia's are hallmark of real seizures. We set out to see any EKG changes (rate and rhythm) occurred during the PNES-ictus and compared to base line. Methods: There were about 300 patients who had video-EEG monitoring done in the Epilepsy Monitoring Unit of National Neuroscience Institute at King Fahad Medical City, between, 2007-2012. We found 24 patients who were diagnosed as PNES based on video-EEG evaluations. The PNES spells were characterized as 1. Sensory, 2. Motor and 3. Behavioral. The EKG changes (rate and rhythm) during the event were noted and compared it to the baseline for each patient. We also collected the patient's demographics, presence of co-morbidities, duration of symptoms, number/type of events, history of using AEDs and MRI findings. Results: Our cohort had 19 females (79%) and 5 males (21%) with mean (+ SD) age 25.3 (+9) years. 18 patients had no co-morbidities, remaining each had a history of road traffic accident, head trauma, diabetes mellitus, bronchial asthma and mental retardation. Average duration of symptoms onset was 6.5(+7) years. Nine patients were on AEDs. During EMU monitoring total number of typical spells recorded were 143, with average of 6 events per subject. Twelve (50%) patients had motor events, 6 (25%) had sensory, and 6(25%) had behavioral. Average duration of all events was 4.5 minutes with (3.9 minutes for motor, 8 minutes for sensory, 2.5 minutes for behavioral). All patients had normal ictal EEG and neuroimaging. EKG finding in all patients had baseline sinus rhythm with mean heart rate 69 (range: 60-90) beats/minute (motor: 67, sensory: 70, behavioral: 70). During the event, 22/24 (92%) patients had mean increase in the heart rate to 89 beats/minute (motor: 101, sensory: 77, behavioral: 91) with overall increment of 22.7% compared to baseline (see table). Five patients (4 from motor group and one from behavior group) developed sinus tachycardia (HR >100) although no arrhythmias were documented. Only 2 patients, both with sensory events, had no ictal change in the heart rate and rhythm. Conclusions: Increased heart rate without change in the rhythm was seen in majority of patients with PNES; maximal percent increment in patients with motor symptoms. However, ictal sinus tachycardia was seen in only one-quarter of patients.