Abstracts

Rationale: To report clinical features and associated psychiatric diagnosis in men with pseudoseizures confirmed by video-EEG monitoring.Methods: Retrospective record review of 680 admissions to the adult epilepsy monitoring unit from 3/97 to 5/07 identified 176 patients with the diagnosis of pseudoseizures or psychogenic seizures.Results: 28.4% (50/176) of the identified patients with pseudoseizures were men. 76% (36) of the men were Caucasian men (CM) while 28% (14) were African American men (AAM). Mean age at admission was 38.9 years old, range (16-74) with a mean age of onset of pseudoseizures of 29.6 years old. The average duration of pseudoseizures was 8.1 years. However, AAM were younger at onset (21 years old) and had a longer duration of pseudoseizures (15.7 years), compared to CM who were older at diagnosis (33.4 years) and had a shorter duration of seizures (5.2 years). 78% (39/50) of all men were on antiepileptic drugs (AEDs) with 51.3% (20/39) of them on polypharmacy. More AAM were on AEDs, 92.9% (13/14) compared to CM, 72.2% (26/36). All men had a high seizure burden with seizures ranging from daily to at least once per week in 76% (38/50). Additionally, 76% (38/50) of men had predominately motor manifestations. However, 92.9% (13/14) of AAM had motor manifestations compared to 69.4% (25/36) of the CM. 70% (35/50) of the men had spells within the first 24 hours of admission. An average of 5.1 pseudoseizures were recorded over an average of 4.8 days in the monitoring unit. CM averaged 5.75 pseudoseizures per admission compared to 3.36 for AAM. This was due to 6 CM having 10 or more pseudoseizures, while none of the AAM had 10 or more. There were no injuries during the episodes. However, one man was restrained who was propelling himself out of bed head first. There was a single instance of incontinence during a spell. Only 8% (4/50) of men had focal epileptiform changes on their EEG. 30% (15/50) of men had a prior psychiatric diagnosis. However, 40% (21) of men were on psychotrophic medications at the time of admission. The most common psychiatric diagnosis was depression in 80% (12/15). In AAM the only diagnosis previously given was depression in 28.6% (4/15). In CM 22.2% (8/36) were diagnosed with depression, but additionally 25% (9/36) had other psychiatric diagnoses. A history of life trauma was more common in men 46 % (23/50), while a history of sexual abuse was rarely reported, 2% (1/50). A family history of seizures was reported in 18% (9/50) of the patients. A slightly higher rate was reported in AAM, 28.6% (4/14), compared to CM, 13.9% (5/36).Conclusions: Although more commonly seen in women, pseudoseizures are also common in men. Pseudoseizures were more commonly of earlier age of onset with a longer duration and frequent motor features in AAM compared to CM. AAM were also more commonly treated with AEDs. Prior known psychiatric pathology occurs in the majority of men, predominately depression. Depression was the only psychiatric diagnosis in AAM. Life trauma was common in men and sexual abuse was rare.