Citation

Altalib HH, Galluzzo D, Argraves S, Goulet J, Bornovski Y, Cheung KH, Jackson-Shaheed E, Tolchin B, Fenton BT, Pugh MJ. Neuropsychiatr. Dis. Treat. 2019; 15: 3557-3568.

Copyright

(Copyright © 2019, Dove Press)

DOI

10.2147/NDT.S234852

PMID

unavailable

Abstract

BACKGROUND: Functional neurological disorders (FNDs) are neurological symptoms that cannot be explained by an underlying neurological lesion or other medical illness and that do not have clear neuropathological correlates. Psychogenic non-epileptic seizures (PNES) are a common and highly disabling form of FND, characterized by paroxysmal episodes of involuntary movements and altered consciousness that can appear clinically similar to epileptic seizures. PNES are unique among FNDs in that they are diagnosed by video electroencephalo-graphic (VEEG), a well-established biomarker for the disorder. The course of illness and response to treatment of PNES remain controversial. This study aims to describe the epidemiology of PNES in the Department of Veterans Affairs Healthcare System (VA), evaluate outcomes of veterans offered different treatments, and compare models of care for PNES.

METHODS: This electronic health record (EHR) cohort study utilizes an informatics search tool and a natural language processing algorithm to identify cases of PNES nationally. We will use VA inpatient, outpatient, pharmacy, and chart abstraction data across all 170 medical centers to identify cases in fiscal years 2002-2018. Outcome measurements such as seizure frequency, emergency room visits, hospital admissions, suicide-related behavior, and the utilization of psychotherapy prior to and after PNES diagnosis will be used to assess the effectiveness of models of care.

DISCUSSION: This study will describe the risk factors and course of treatment of a large cohort of people with PNES. Since PNES are cared for by a variety of different modalities, treatment orientations, and models of care, effectiveness outcomes such as seizure outcomes and utilization of emergency visits for seizures will be assessed. Outcome measurements such as seizure frequency, emergency room visits, hospital admissions, suicide-related behavior, and psychotherapy prior to and after PNES diagnosis will be used to assess the effectiveness of models of care. © 2019 Altalib et al.

Language: en

Keywords

human; suicide; incidence; traumatic brain injury; depression; prevalence; medical education; chronic pain; mindfulness; disease severity; natural language processing; posttraumatic stress disorder; risk factor; hospital admission; serotonin uptake inhibitor; population research; anxiety disorder; emergency ward; seizure; videorecording; Article; VA; acceptance and commitment therapy; psychodynamic psychotherapy; veterans health; cognitive behavioral therapy; pain intensity; electronic health record; Electronic health record; EHR; FND; Functional neurological disorders; numeric rating scale; PNES; psychogenic nonepileptic seizure; Psychogenic nonepileptic seizures; Veterans administration; video electroencephalography