title: Psychogenic nonepileptic seizures in US veterans.
abstract: OBJECTIVE
  Psychogenic nonepileptic seizures (PNES) are frequently encountered in epilepsy monitoring units (EMU) and can result in significant long-term disability. We reviewed our experience with veterans undergoing seizure evaluation in the EMU to determine the time delay to diagnosis of PNES, the frequency of PNES, and cumulative antiepileptic drug (AED) treatment. We compared veterans with PNES to civilians with PNES studied in the same EMU.
  
  
  METHODS
  We reviewed records of all patients admitted to one Veterans Affairs Medical Center (VAMC) EMU over a 10-year interval. These patients included 203 veterans and 726 civilians from the university affiliate. The percentage of patients with PNES was calculated for the veteran and civilian groups. Fifty veterans with only PNES were identified. Each veteran with PNES was matched to the next civilian patient with PNES. The 2 groups were compared for interval from onset of the habitual spells to EMU diagnosis, cumulative AED treatment, and other measures.
  
  
  RESULTS
  PNES were identified in 25% of veterans and 26% of civilians admitted to the EMU. The delay from onset of spells to EMU diagnosis averaged 60.5 months for veterans and 12.5 months for civilians (p < 0.001). Cumulative AED treatment was 4 times greater for veterans with PNES as compared to civilians (p < 0.01). Fifty-eight percent of veterans with PNES were thought to have seizures related to traumatic brain injury.
  
  
  CONCLUSIONS
  The results indicate a substantial delay in the diagnosis of PNES in veterans as compared to civilians. The delay is associated with greater cumulative AED treatment.
authors: Portland Veterans Affairs Medical Center and Oregon Health & Sciences University, Portland, OR, USA. Salinsky@ohsu.edu
authors: Martin
authors: M
authors: Salinsky
authors: David
authors: D
authors: Spencer
authors: Eilis
authors: E
authors: Boudreau
authors: Felicia
authors: F
authors: Ferguson
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006787:Hospitals, Veterans / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D014481:United States / Q000453:epidemiology; D014728:Veterans; D055815:Young Adult