Abstracts

Rationale: Approximately 20% of patients with PNES fail to attend their first appointment after diagnosis and 86% of patients drop out of psychiatric follow-up within 18 months. We conducted a prospective cohort study to identify predictors of adherence with psychotherapy and to examine correlations between treatment adherence and outcomes, including improvement in seizure frequency, quality of life, and emergency department utilization. Methods: We prospectively followed 105 consecutive subjects newly diagnosed with PNES. Subjects were recommended for a course of psychotherapy. Manualized psychotherapy regimens typically require a minimum of 12 weekly sessions.At the time of diagnosis (baseline) and again at 12-24 month follow-up, we assessed PNES frequency, quality of life (as measured by the Quality of Life in Epilepsy-10 or QOLIE-10) and emergency department utilization.Subjects were considered to be adherent with psychotherapy if they attend at least 8 sessions. Covariates were assessed for correlation with adherence using logistic regression, with a univariate screen followed by construction of a multivariate model. Results: Subjects attended a median of 6 weekly psychotherapy sessions over a 16-week period following diagnosis (FIGURE). Only 40% of subjects attended 8 or more therapy sessions.We conducted logistic regression to evaluate covariates potentially associated with non-adherence with treatment. Covariates that correlated with adherence in a univariate screen include: being on disability at the time of diagnosis, self-identified minority status, and a history of childhood abuse (TABLE). Self-identified minority status and a history of childhood abuse remaine as independent predictors of non-adherence in the multivariate model.When evaluated at 12-24 month follow-up, 61% of subjects who are non-adherent with psychotherapy achieve a significant reduction in seizure frequency (>50% reduction from baseline seizure frequency). In contrast 84% of subjects who are adherent with treatment achieve a significant reduction in seizure frequency (p-value=0.021).Adherence with psychotherapy remains a statistically significant predictor of 50% reduction in seizure frequency when potential confounders such as age, gender, minority status, and a history of childhood abuse are controlled for in a multivariate model (odds ratio 3.37, p-value=0.046).Non-adherent subjects had a mean 2.8 point improvement in quality of life on the 50 point QOLIE-10 while adherent subjects had an average 7.2 point improvement (p-value=0.044).Non-adherent subjects had an average increase of 0.4 more ED visits per 3 month interval from baseline to follow-up, while adherent subjects had an change of 0.8 fewer ED visits per 3 month interval (p-value=0.040). Conclusions: Among patients with PNES, only 40% of patients are adherent with psychotherapy.Independent predictors for non-adherence include self-identified minority status and a history of childhood abuse.Adherence with psychotherapy correlates with greater reduction in seizure frequency, improvement in quality of life, and decrease in emergency department visits. Funding: American Academy of Neurology/American Brain Foundation