Abstracts

Rationale: Psychogenic non-epileptic seizures (PNES) are diagnosed in 25% of Veterans admitted to Epilepsy Monitoring Units (EMU) within the Veterans Affairs Medical System (VAMC). There are no existing data regarding the outcome of these patients. This information is important for planning therapeutic trials and assessing prognostic factors. The outcome of Veterans with PNES may differ from that of civilians due to the age and sex of the patients, proposed seizure etiologies, and the nature of the medical system.Methods: We performed a structured chart review of all patients meeting research criteria for PNES at the Portland, Oregon VAMC EMU, 2000-2011. Patients with both epileptic seizures and PNES were excluded. Review sources included the electronic medical record, linked medical records from other VAMCs (Vistaweb), and scanned medical records (Vistaimaging). All provider notes were reviewed for information regarding seizure frequency, seizure description, antiepileptic drug (AED) usage, and seizure related emergency department visits. Results were compiled for the first year post-diagnosis (months 1-12), and months 13-36. Seizure outcome was classified as (1) seizure free; (2) >50% reduction; (3) no improvement. Results: Sixty-two patients met research criteria for PNES. Seizure activity: 51 patients (82 %) had adequate records regarding seizure activity during the first year post-diagnosis (the remainder were lost to follow-up). Thirteen (26%) were seizure free, and 38 (74%) had further seizures. Eleven (22%) had a >50% reduction in seizure frequency. The remainder (52%) had no improvement in seizure frequency. Thirty-three patients (67%) had adequate records for seizure activity during the 13-36 month interval. Twelve (36%) were seizure free, including 6 who had been seizure free for the 1-12 month interval. Six other patients had a >50% reduction in seizure frequency. AED usage: AED usage 12 months after EMU-discharge was recorded for 54 PNES patients, 43 (80%) of whom were on one or more AEDs for seizures at EMU admission. At EMU discharge AEDs were discontinued in 41 of 43 patients. At 12 months follow-up 37 patients (86%) remained off any AED for seizures. Four patients had AEDs restarted by providers (3) or self (1). Three of the six patients remaining on AEDs had reduced from 2 AEDs to 1. AED use 36 months after EMU discharge was documented for 27 of the 43 patients. Twenty-two (81%) remained off AEDs at 36 months. All had been off AEDs at the 12 month follow-up. Conclusions: Following EMU diagnosis of PNES a majority of Veterans continued to report seizures during 3 years of follow-up. Less than 20% remained seizure free through the 36 month interval, and most had no significant improvement. These unsatisfactory outcomes underscore the need for effective PNES treatment protocols within the VAMC. However, more than 80% of PNES patients who had received AEDs for seizures prior to EMU evaluation remained continuously off AEDs through 36 months of follow-up, eliminating potentially harmful effects and reducing cost of care.