Article

Patient Understanding of Psychogenic Nonepileptic Seizure Diagnosis Improves Outcomes


 

References

Informed patients were significantly more likely than others to experience a full resolution of their seizures.

BOSTON—Patients diagnosed with psychogenic nonepileptic seizures who understood and were satisfied with their diagnosis were more likely to show improvement or even be seizure-free one year postdiagnosis, researchers from the University of Minnesota and Minnesota Epilepsy Group reported at the 63rd Annual Meeting of the American Epilepsy Society.

Jason Bisping, MD, and colleagues included 30 adults who were diagnosed with psychogenic nonepileptic seizures at the Minnesota Epilepsy group between 2006 and 2007. The researchers tracked patients’ clinical course via telephone interview at 18 months postdiagnosis. Of the subjects contacted, 80% said their seizures had improved in frequency or intensity since diagnosis, and 43% reported that they were presently seizure-free.

When asked about the meeting in which they received the diagnosis of psychogenic nonepileptic seizures, 93% of participants were able to recall the meeting, and 57% said they were “satisfied” with the diagnosis. The researchers noted that patients who were satisfied with their diagnosis were more likely to be seizure-free (69% vs 47%). Patients who claimed to have a good understanding of their diagnosis (57%) were also more likely to be seizure-free (91% vs 47%).

“This study emphasizes just how important a clear and formal presentation of the diagnosis of psychogenic nonepileptic seizures is to individual patient outcomes,” Dr. Bisping told Neurology Reviews. “This suggests that how the diagnosis is delivered may affect patients’ success in fully resolving their spells. Investing time and effort with individual patients into understanding their diagnosis may actually help them to resolve their seizures more effectively.” Dr. Bisping is an Epilepsy Fellow at the University of Minnesota in Minneapolis.

Patient Follow-up Care
Just over half of the subjects (53%) attended a follow-up visit with the diagnosing physician after discharge, and only one-third established care with a mental health provider, despite referral, the researchers wrote. Of those with current mental health care treatment, 43% were reportedly under the care of a psychiatrist and 43% were seeing a therapist; 30% were currently taking an antiepileptic drug.

“Adjunctive psychologic treatment remains an important tool in the treatment of psychogenic nonepileptic seizures,” the study authors wrote. “Despite this, a large proportion of patients fail to establish care with mental health providers. Many also fail to attend a clinic with their epileptologist once a diagnosis has been made. Compliance with follow-up is an area ripe for improvement at centers that routinely diagnose psychogenic nonepileptic seizures.”

“This surprisingly low rate of attendance for follow-up appointments and for referrals to counselors makes providing patients with education on psychogenic nonepileptic seizures while in the hospital even more crucial,” Dr. Bisping added.

Effect on Quality of Life
Overall quality-of-life scores, measured using a modified QOLIE-10 format, were higher in patients who were seizure-free (69.2% vs 52.9%). No seizure-free patients reported social limitations, 76.9% were driving, and the same number reported feeling totally independent. Rates of depression, however, were higher in this group as well.

“Psychogenic nonepileptic seizures have a profound effect on patients’ quality of life,” the researchers reported. “For those patients whose spells persist over time, a lower overall quality of life and a less independent lifestyle can be anticipated.”

Dr. Bisping added that patients with psychogenic nonepileptic seizures account for 30% of admissions to dedicated epilepsy centers. “This underscores the need to improve outcomes for this large group of patients,” he said. “The diagnosis is also high stakes, with profound medical, financial, and lifestyle consequences for patients and health care systems alike.”


—Rebecca K. Abma

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