title: Health resource utilization among US veterans with psychogenic nonepileptic seizures: A comparison before and after video-EEG monitoring.
abstract: OBJECTIVE
  Prior to establishing the correct diagnosis, patients with psychogenic nonepileptic seizures (PNES) frequently endure significant costs and morbidities associated with utilization of health care resources. In this study of the US veterans population, we aimed to investigate for potential changes in health resource utilization before versus after video-EEG (VEEG) confirmation and disclosure of the PNES diagnosis.
  
  
  METHODS
  We prospectively studied 65 veterans with VEEG confirmed diagnosis of PNES, and followed their health care utilization during the subsequent 3 years after the diagnosis. Primary outcomes entailed comparing the quantities of post-VEEG outpatient visits and diagnostic procedures versus those during the 3-year span prior to the diagnosis. Secondary outcome involved specifically the measures of seizure-related antiepileptic drug (AED) use from time points before and after VEEG.
  
  
  RESULTS
  Within the category of non-psychiatric outpatient visits, we observed significant post-diagnostic decrease in the utilization of PNES-related outpatient visits (p < 0.001). Contrastingly, we found significant post-diagnostic increase in the utilization of non-PNES-related outpatient visits (p = 0.004). When examining exclusively for psychiatric outpatient visits, we further observed a trend toward increased attendance of outpatient visits (p = 0.056) after VEEG. Utilization of diagnostic procedures was not significantly different before versus after VEEG (p = 0.293). 52.3% of the patients were prescribed AEDs for seizure-related purpose during the one-year period leading up to VEEG. By comparison, only 7.7%, 12.3%, and 10.8% of the patients were still on AEDs for seizure-related purpose at the one-year, two-year, and three-year time points after VEEG, respectively.
  
  
  CONCLUSIONS
  We demonstrate new evidence that VEEG confirmation of the PNES diagnosis among US veterans can significantly reduce key measures of non-psychiatric/PNES-related resource utilization, while also potentially associating with appropriate enhancement of psychiatric outpatient visits. However, our results suggest that within this patient population, further efforts are necessary to address heightened demands for non-PNES-related outpatient visits after VEEG.
authors.affiliation: Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Karen R
authors.initials: KR
authors.lastname: Nunez-Wallace
authors.affiliation: Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Dona K
authors.initials: DK
authors.lastname: Murphey
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, and Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Proto
authors.affiliation: Department of Neurology, Baylor College of Medicine, Houston, TX, USA; Neurology Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Collins
authors.affiliation: Neurology Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
authors.forename: Romay
authors.initials: R
authors.lastname: Franks
authors.affiliation: Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: D Michael
authors.initials: DM
authors.lastname: Chachere
authors.affiliation: Peter Kellaway Section of Neurophysiology, Department of Neurology, Baylor College of Medicine, Houston, TX, USA; Neurology Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA. Electronic address: dkchen@bcm.edu.
authors.forename: David K
authors.initials: DK
authors.lastname: Chen
mesh_terms: D000328:Adult; D017668:Age of Onset; D000927:Anticonvulsants / Q000627:therapeutic use; D017281:Cost of Illness; D004569:Electroencephalography; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D011446:Prospective Studies; D011602:Psychophysiologic Disorders / Q000175:diagnosis; D012640:Seizures / Q000175:diagnosis* / Q000191:economics* / Q000628:therapy; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States; D014728:Veterans
chemical_list: D000927:Anticonvulsants
keywords: Health care resource utilization; Pseudoseizures; Psychogenic nonepileptic seizures; Veterans; Video-EEG monitoring