Psychosocial and Physiologic Characteristics of Patients with Non-epileptic Events: A Retrospective Study of Rural Patients (P6.270)

Objective: This study will determine if there is any correlation of socio-demographic factors and psychological co-morbidities with psychogenic non-epileptic seizures (PNES) in adults diagnosed by video electroencephalogram (EEG) monitoring at our tertiary referral center. Background: PNES is a common phenomenon that contributes to about 40% of video EEG characterization in specialty epilepsy centers with an estimated cost in excess of 650 million dollars annually. The diagnosis of PNES can often be delayed by failure to consider the events as non-ictal in nature. This can lead to the inappropriate use of anti-epileptic drugs with possible untoward side effects and socioeconomic impact of the inappropriate diagnosis. Failure to diagnose PNES leads to frequent Emergency Department visits and hospitalizations leading to increased health care expenditures. Design/Methods: This study is a retrospective chart review. We analyzed PNES subject data from video EEG monitoring performed at the Epilepsy center in Cabell Huntington Hospital. We reviewed more than 360 episodes in 54 subjects of age > 18 years. Results: The mean age ± SD was 48 ± 12.97 years and 83% were females. We found that most of our PNES patients were older (> 45 years of age) 36 (66.7%), females 43 (83.3%), obese 36 (66.7%) or overweight 10 (18.5%), either single 18 (33.3%), separated 4 (7.4%), divorced 12 (22.2%), and widow 8 (14.8%), education less than 12 th grade 49 (90.7%), unemployed {either received government assistance 45 (83.3%) or disability benefits 31 (57.4%)} with associated physical 46 (85.2%) and psychiatric illness 52 (96.3%). Conclusions: The outcome of our study indicates the need for collaboration between psychiatrist, psychotherapist and neurologist for the diagnosis and management of PNES. It adds to the current knowledge of socio-demographic and socio-cultural variability of PNES and might aid earlier recognition of PNES. This will enable reduction of health care expenditure, inappropriate management with antiepileptic medication and morbidity. Disclosure: Dr. Nemade has nothing to disclose. Dr. Ferguson has received research support from Sun Pharmaceuticals, Novartis. Dr. Shah has nothing to disclose.