title: Recognition of psychogenic nonepileptic seizures diminishes acute care utilization.
abstract: Patients with psychogenic nonepileptic seizures (PNES) frequently use acute health care resources including emergency departments (EDs), resulting in redundant efforts. We asked whether establishing the diagnosis of PNES via video/EEG telemetry reduces subsequent ED use. Twenty-three patients with PNES were studied over a 48-month period surrounding the diagnosis using a provincewide database. There was a 39% reduction in total ED visits and a 51% reduction in ED visits for neurological causes during the 24 months following the diagnosis, and decreased ED use persisted throughout the follow-up period. There was no significant change in ED utilization for psychiatric causes. The proportion of patients with PNES who used ED services once or not at all per year increased from 26% in the 2 years prior to the diagnosis to 57% following the diagnosis. These findings suggest that a definitive, telemetry-based diagnosis relieves diagnostic uncertainties for the patient and physician, but also has quantifiable economic benefits.
authors.affiliation: Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada. jeff.jirsch@ualberta.ca
authors.forename: J D
authors.initials: JD
authors.lastname: Jirsch
authors.forename: S N
authors.initials: SN
authors.lastname: Ahmed
authors.forename: K
authors.initials: K
authors.lastname: Maximova
authors.forename: D W
authors.initials: DW
authors.lastname: Gross
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004569:Electroencephalography / Q000191:economics / Q000379:methods; D004632:Emergency Medical Services / Q000191:economics* / Q000379:methods; D005260:Female; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011602:Psychophysiologic Disorders / Q000175:diagnosis* / Q000191:economics* / Q000523:psychology; D012640:Seizures / Q000175:diagnosis* / Q000191:economics* / Q000523:psychology; D014600:Utilization Review / Q000706:statistics & numerical data; D014741:Video Recording / Q000191:economics; D055815:Young Adult