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I hope you forgive the new thread.
I know the recent thread about Conversion Disorder talked a bit about Psychogenic Non-Epileptic Seizures , but I wanted to start a new thread about it, focusing on the political difficulties (admin to billing) in diagnosing, but the help it can provide to patients/families.
from Journal Watch - Psychiatry
Benefits of Diagnosing Psychogenic Nonepileptic Seizures
After diagnosis, patients use less medicine, have less treatment, and start working.
Recently, quality of life in patients with psychogenic nonepileptic seizures (PNES) was shown to correlate with depression, not seizure frequency (JW Psychiatry Aug 31 2009). This new study examines outcomes of 260 consecutive patients 12 months after being diagnosed with PNES.
Most patients were women (75%); 72% had at least one follow-up visit. After PNES diagnosis, seizure frequency significantly diminished: 38% of patients had no episodes for 2 months, and another 23% had at least a 50% reduction in frequency. Among those still having episodes, mean monthly episodes increased from 24 to 43. Fewer patients used antiepileptic drugs (AEDs) (from 52% to 13%) or emergency services (from 50% to 16%); even among patients with continued episodes, 74% had no emergency visits. Employment increased from 10% to 24%, but the percentage of patients receiving Social Security payments changed little.
Having an anxiety or depression disorder or receiving Social Security was significantly associated with decreased likelihood for being spell-free (odds ratio, 0.43). Men were more likely than women to become spell-free. Having other medically unexplained symptoms or a learning disability predicted increases in spell frequency.
Comment: The diagnosis of PNES decreased AED use and emergency visits and increased employment. These are all important changes that lower the societal burden and cost of treatment and increase patients' quality of life. Receiving Social Security, having other unexplained symptoms, and having a psychiatric diagnosis were negative prognostic factors. Thorough evaluation and diagnosis as early as possible probably offsets the cost of evaluation. We need to refer patients with seizure-like episodes for rapid evaluation and for treatment of these and psychiatric sequelae.
Jonathan Silver, MD
Published in Journal Watch Psychiatry February 12, 2010
CITATION(S):
McKenzie P et al. Early outcomes and predictors in 260 patients with psychogenic nonepileptic attacks. Neurology 2010 Jan 5; 74:64.
Original article (Subscription may be required)
Medline abstract (Free)
I know the recent thread about Conversion Disorder talked a bit about Psychogenic Non-Epileptic Seizures , but I wanted to start a new thread about it, focusing on the political difficulties (admin to billing) in diagnosing, but the help it can provide to patients/families.
from Journal Watch - Psychiatry
Benefits of Diagnosing Psychogenic Nonepileptic Seizures
After diagnosis, patients use less medicine, have less treatment, and start working.
Recently, quality of life in patients with psychogenic nonepileptic seizures (PNES) was shown to correlate with depression, not seizure frequency (JW Psychiatry Aug 31 2009). This new study examines outcomes of 260 consecutive patients 12 months after being diagnosed with PNES.
Most patients were women (75%); 72% had at least one follow-up visit. After PNES diagnosis, seizure frequency significantly diminished: 38% of patients had no episodes for 2 months, and another 23% had at least a 50% reduction in frequency. Among those still having episodes, mean monthly episodes increased from 24 to 43. Fewer patients used antiepileptic drugs (AEDs) (from 52% to 13%) or emergency services (from 50% to 16%); even among patients with continued episodes, 74% had no emergency visits. Employment increased from 10% to 24%, but the percentage of patients receiving Social Security payments changed little.
Having an anxiety or depression disorder or receiving Social Security was significantly associated with decreased likelihood for being spell-free (odds ratio, 0.43). Men were more likely than women to become spell-free. Having other medically unexplained symptoms or a learning disability predicted increases in spell frequency.
Comment: The diagnosis of PNES decreased AED use and emergency visits and increased employment. These are all important changes that lower the societal burden and cost of treatment and increase patients' quality of life. Receiving Social Security, having other unexplained symptoms, and having a psychiatric diagnosis were negative prognostic factors. Thorough evaluation and diagnosis as early as possible probably offsets the cost of evaluation. We need to refer patients with seizure-like episodes for rapid evaluation and for treatment of these and psychiatric sequelae.
Jonathan Silver, MD
Published in Journal Watch Psychiatry February 12, 2010
CITATION(S):
McKenzie P et al. Early outcomes and predictors in 260 patients with psychogenic nonepileptic attacks. Neurology 2010 Jan 5; 74:64.
Original article (Subscription may be required)
Medline abstract (Free)
