Resource Utilization in Patients with Suspected Psychogenic Non Epileptic Seizures and Drug Resistant Epilepsy in the Harris County Health District between 2009 and 2012 (P5.070)

OBJECTIVE: Our intent is to quantify resource utilization amongst patients with drug resistant epilepsy and psychogenic non epileptic seizures. Thus, we hope to demonstrate the need for more cost effective management strategies in this patient population. BACKGROUND: Both drug resistant epilepsy (DRE) and psychogenic non-epileptic seizures (PNES) demonstrate high comorbid psychiatric illness. We hypothesize that seizure-related and psychiatric utilization are comparable between patients with DRE and PNES. DESIGN/METHODS: In a retrospective chart review, we quantified outpatient and ER seizure-related and psychiatric utilization in the Harris County Hospital District by all patients for whom neurology encounters from January 2009-January 2012 suggested a diagnosis of DRE, PNES, or related neither (i.e. syncope, provoked seizures). DRE was defined as use of two concurrent AEDs at therapeutic doses with greater than one seizure per year. Seizures (or suspected PNES) were defined by clinical history, EEG, and MRI. Video EEG was unavailable for definitive PNES diagnosis. For the first 105 patients, we used nonparametric analyses (kstest2, kruskalwallis in Matlab) to determine whether there were statistically significant differences in utilization between groups and effects of group membership on seizure-related and psychiatric visits. RESULTS: Seizure related utilization was not different between patients with DRE versus suspected PNES (p = 1). There was, as expected, a strong effect of a psychiatric diagnosis on the number of psychiatry visits (p < 0.001) and interestingly, an effect of PNES suspicion on number of psychiatry visits (p = 0.03) but not on number of seizure-related visits (p = 0.30). CONCLUSIONS: Despite the diagnostic utility of video-EEG in DRE and diagnostic/therapeutic utility in PNES, this tool has not been widely adopted by entities providing indigent care. We provide preliminary evidence that patients with suspected PNES incur as much seizure-related and more psychiatry utilization than patients with DRE. Even in centers where a surgical epilepsy program does not exist, definitive video-EEG diagnosis of PNES and ensuing decreases in utilization may result in significant savings. Disclosure: Dr. Wolf has nothing to disclose. Dr. Hayashi has nothing to disclose. Dr. Sachs has nothing to disclose. Dr. Van Hook has nothing to disclose. Dr. Murphey has nothing to disclose. Dr. Goldsmith has nothing to disclose.