Outcomes of Patients Diagnosed with Psychogenic Non-Epileptic Seizures

BACKGROUND: Psychogenic Non-Epileptic Seizures (PNES) is a complex neuropsychiatric illness that is very difficult to diagnose due to complex comorbidities and symptoms. There are also several risk factors associated with development of PNES that can contribute to the patient's presentation. However, there is very little literature on patient outcomes, management guidelines, and prognostic factors. Therefore, patients may not receive treatment according to a standard of care or in a streamlined manner which may worsen patient outcomes. OBJECTIVE: This study will examine 1) if patient outcomes improve with psychiatric or multidisciplinary management and 2) the influence of specific risk factors on patient outcomes. METHODS: This was a retrospective cohort study with data from chart review of the Parkland EMR. A total of 122 patients were examined who were diagnosed with PNES during an EMU admission in 2016. Demographic variables, risk factors for PNES, and treatment intervention information were extracted from each patient chart to be compared with the primary outcome variable. Patient outcomes were measured by recurrent symptoms leading to ED visits and/or EMU admissions after the initial 2016 admission. Descriptive analysis was done using Excel while statistical analysis comparing independent variables to patient outcome variables was done using SPSS 25. If the independent variable was a categorical variable, chi-square tests were used, but for continuous variables, Kruskal-Wallis rank sum tests were used. RESULTS: Preliminary findings showed no significant associations between receiving any singular intervention and patient outcomes. Unexpectedly multidisciplinary management such as therapy and psychiatric follow-up had no significant relationship with patient outcomes. Risk factors that may be associated with increased recurrent PNES symptoms include prior psychiatric disorders, prior ED visits or EMU admissions, and socioeconomic factors such as type of insurance and homelessness. CONCLUSION: Although multidisciplinary management did not show significant reduction in readmissions or ED visits for PNES symptoms, prior literature shows that psychiatric/psychological involvement can improve PNES outcomes. Treatment of PNES should be tailored for patients based on psychiatric/neurologic comorbidities and risk factors. Future research will need to explore the benefits of combinations of interventions and a multidisciplinary clinic such as a PNES clinic for these patients.