Relevance of Psychogenic and Epileptic Seizures Coexisting in an Epilepsy Monitoring Unit Population (P4.257)

OBJECTIVE: To determine the relevance of coexisting psychogenic non-epileptic seizures (PNES) and epileptic seizures (ES) recorded in patients during epilepsy monitoring unit (EMU) evaluations. BACKGROUND: It is well established that PNES and ES may coexist in a patient, but patients with both ES and PNES recorded simultaneously in EMU evaluations are not well described. DESIGN/METHODS: We retrospectively reviewed all epilepsy monitoring patients at the University of Maryland Medical Center over an 18 month period to determine the incidence of both PNES and ES coexisting in a patient as documented by capturing both PNES and ES during that admission. RESULTS: Of our 256 total epilepsy monitoring patients, 167 (65%) were female, and the mean age was 41 years (range 16-88, standard deviation 14.7). Of the total patients, 70 (27%) were judged to have PNES during their admission, and 8 (11.4%) of these PNES patients had well documented coexisting epileptic seizures as determined by video EEG during that same admission. CONCLUSIONS: The percentage of co-existing PNES and ES captured on video EEG monitoring in our patients (11.4% of all PNES patients) was higher than expected, and may relate in part to aggressive seizure medication tapers to provoke events, thereby unmasking ES in patients with documented PNES and a pre-existing propensity or risk for ES (3 patients). In addition, for several (5) of these patients with apparent PNES, the possibility that these were embellished epileptic auras mimicking PNES warrants consideration. Still, the incidence of co-existing ES and apparent PNES in such a high percentage of patients is notable and suggests that caution is warranted when tapering seizure medication in some patients with PNES. Also further study of management and outcomes in ES patients with presumed PNES versus embellished epileptic auras seems warranted. Study Supported by: Rosen Foundation Disclosure: Dr. Krumholz has nothing to disclose. Dr. Thomas has nothing to disclose.