Therapeutic Utility of Long-Term Monitoring Diagnosis in Psychogenic Nonepileptic Events (PNEE) on Patient Illness Perception and Hospital Resource Utilization (S08.004)

OBJECTIVE: To determine how psychogenic non-epileptic events (PNEE) and hospital resource utilization change over time prior to and following long-term monitoring (LTM) diagnosis of PNEE using the Michael E. DeBakey Veteran Affairs Medical Center (MEDVAMC) EMR data and questionnaires in Houston, Texas. BACKGROUND: LTM is considered the gold standard in the diagnosis of PNEE, resulting in diagnostic changes and altering clinical management in 24-71% of referrals made to tertiary referral. The average delay in diagnosis of PNEE approaches 7 years, during which time these patients receive unnecessary workup and treatment including ER and outpatient visits (O), inpatient and ICU admissions (I), and antiepileptic drugs (A), all with associated costs and morbidities (5). DESIGN/METHODS: A sequential list of 65 patients admitted for LTM to the VAMC from 2009 to 2012 was used for review of all encounters. All O, I, and A up to 7 years prior to and 1 year following definitive LTM diagnoses of PNEE were quantitatively and qualitatively analyzed to determine how resource utilization changed and how diagnosis affected patients9 illness experience and productivity. All analyses were performed in Matlab. RESULTS: There was a trend toward fewer outpatient visits related to PNEE as well as various other diagnoses following LTM. There were far fewer inpatient visits and no ICU admissions for PNEE either before or after LTM. AED use also declined after diagnosis. PNEE frequency and intensity, productivity, did not change as readily per patient questionnaires, yet disatisfaction with PNEE diagnosis was not instantiated through search for a second opinion or development of new unexplained symptoms. CONCLUSIONS: Despite variable improvement of PNEE frequency and intensity, and self-reported productivity, the patients do appear to utilize health-care resources less. Supported by: Advancing Clinical Excellence resident research grant at Baylor College of Medicine. Disclosure: Dr. Nunez-Wallace has nothing to disclose. Dr. Murphey has nothing to disclose. Dr. Chen has nothing to disclose.