Abstracts

Rationale: There is increasing evidence for the effectiveness of psychological interventions in patients with epilepsy and those with Psychogenic Non-epileptic Seizures (PNES). However, access to psychological service providers may be restricted because of the risk of seizures. This study explores the risk of in-session epileptic seizures and PNES.  Methods: Consecutive patients with epilepsy or PNES attending two neurology centres in the United Kingdom for psychological treatment to help with their seizure disorders were studied. Information about seizures during outpatient psychological therapy sessions was gathered using a 12-item pro-forma. Results:  97 patients with epilepsy and 195 with PNES were seen during the study period. Three patients with epilepsy had a total of 7, 26 patients with PNES a total of 48 in-session seizures. The risk of at least one in-session seizure was 1 in 200 treatment sessions provided to patients with epilepsy, and 1 in 29 sessions for those with PNES. One in 32 patients with epilepsy and 1 in 8 patients with PNES had at least one in-session seizure. The risk of such seizures was greater in patients with PNES than epilepsy (odds ratio 4.36, 95% CI 1.28-14.91). Seizures tended to disrupt sessions briefly. Only 1 patient with a cluster of 3 PNES in one session required medical attention and brief in-patient observation was arranged after 6 PNES. Conclusions: In-session seizures are much commoner in patients with PNES than those with epilepsy but rarely cause major disruption to psychological treatment. Although PNES could almost invariably be managed by the psychologist or therapist without help from physicians or emergency care staff, psychotherapy providers have to anticipate the occurrence of in-session seizures and to have safe management plans in place. The fact that PNES occur more commonly than epileptic seizures during psychotherapy sessions adds to our understanding of the mechanisms triggering PNES.  Funding: Unfunded