Abstracts

Rationale: Non-epileptic seizures (NES) are paroxysmal events of altered behavior that outwardly resemble epilepsy but are caused by psychiatric disease. Diagnosis of suspected NES can be made in the outpatient clinic prior to video EEG monitoring by identification of specific NES risk factors and specific elements of seizure semiology from the clinical history. Since psychiatric disease often presents differently in women and men, we questioned whether gender-specific differences exist in NES risk factors and semiology. Such differences can be used to improve the outpatient diagnosis of suspected NES. Methods: Male and female patients were identified from a video EEG monitoring database. Seizure semiology for each patient was analyzed de novo and categorized into one of three established semiology clusters. In addition, patients' medical records were reviewed and data on possible risk factors was obtained. Results: 42 patients were included in the analysis (26 women, 16 men) who ranged in age from 19 to 78 (mean 40.5 years). Among female patients, seizure semiology was classified as major motor in 30.7%, minor motor in 30.7%, and non-motor in 23.8%. Among male patients, seizure semiology was classified as major motor in 43.8%, minor motor in 31.3%, and non-motor in 25%. There were no significant differences between men and women in any of the semiology clusters (major motor X2 = 0.27, p = 0.60; minor motor X2 = 0.1, p = 0.75; and non-motor X2 = 0.32, p = 0.57). Analysis of NES risk factors showed significantly higher rate of reported physical/emotional/sexual abuse (p=0.002), pre-ictal headache (p=0.02), and history of prior suicide attempt (p=0.004) in female patients as compared to male. Conclusions: Our results support the use of the same "semiology criteria" for the outpatient diagnosis of suspected NES in both female and male patients. In contract, our results support the use of variable "risk factor criteria" for making a diagnosis of suspected NES based on gender.