Abstracts

Rationale: Persons with a surgical substrate for there DRE may also have coexisting PNES. Presence of these seizures both pre and post operatively (emergent) would result in a poorer quality of life in these patients. They would also confound postoperative results and cause the outcomes to be worse if they emerge after surgery. Hence we prospectively evaluated and followed up patients with coexisting seizures and there outcomes after 5 years of follow up. Methods: Prospective study and follow up of DRE patients who were evaluated in Unit 1 neurology, from 1999 January to 2006 January. A follow up of 5 years was done on all the patients who subsequently underwent surgery prior to 2006. All patients who had only PNES were excluded from the evaluation and further presurgical workup. All patients who had coexisting psychogenic and true epilepsy were included in the study. The demographic profile was noted. History prior to onset of both seizure types obtained. In few patients PNES emerged de novo during monitoring these were recorded. In some they emerged de novo after surgery this was recorded too. A complete profile of these patients on the NPI, and BPRS was performed . QOLIE-31 was also performed and seizure outcome documented on the Engel scale. Results: A total of 792 recordings of 783 PWE, were review and followed up prospectively. Only 32 of these were psychogenic only seizures both by history and EMU recordings these were excluded from the study. 27 PWE demonstrated a combination seizure type. 6 had de novo appearance of PNES during the EMU recording. 15 PWE underwent surgery as true seizures were the predominant seizure type. The rest were put on follow up, and surgery deferred till the emergence of disabling seizures. 6 from this group eventually moved to the surgical arm. The rest were continued on the best medical treatment. 18 PWE with DRE who underwent surgery during this duration had emergent PNES denovo after surgery. Following surgery 11 PWE with a combination of seizures were seizure free at the end of 5 years with 5 showing a running down phenomenon on the PNES. 4 continued to have seizures 2 both and 1 each PNES and true only. Of the PWE with post surgical burden of epilepsy denovo seizures 17 became seizure free with counseling. Conclusions: Coexistence of both PNES and true seizures should not be a contraindication for epilepsy which should be performed depending on the predominant seizure type. Case by case management with attention to each seizure type is a must in such patients.