Abstract Details

Title The Effect of Adrenergic Modulation Treatment of Psychogenic Nonepileptic Seizures (PNES): A Retrospective Chart Review

Topic Epilepsy

Presentation(s) P03 - (-)

Poster/Presentation
Number 120

Objective

Background BACKGROUND: Numerous case reports suggest that traumatic events are an important risk factor for developing PNES. Several studies have also examined the effects of anti-noradrenergic agents on PTSD symptoms. As PNES may arise as a clinical expression of post-traumatic experiences, adrenergic modulation may be helpful in the treatment of PNES.

Design/Methods DESIGN/METHODS: We performed a retrospective chart review of patients ages 18-70 seen at the University of Missouri Hospital between 2009 and 2012 with confirmed diagnosis of PNES by video EEG monitoring. We reviewed details including age, gender, duration of PNES, psychiatric diagnosis upon discharge, concomitant psychiatric medications, seizure frequency, tolerability and side effects at last known follow-up following initiation of adrenergic modulation therapy. We excluded patients diagnosed with both epileptic and nonepileptic seizures and those who did not follow-up.

Results RESULTS: We reviewed the charts of 14 patients (mean age: 38.6 years), including 3 males (21.4%) and 11 females (78.6%). The duration of PNES studied ranged from 6 months to 30 years. Seven patients were started on Propranolol, 5 on Prazosin, and 2 on Clonidine. The majority of patients had more than one psychiatric diagnosis: PTSD (8), depression (10), anxiety (9), somatization disorder (2). Twelve patients were on SSRI (86%) and AED (86%), 5 on benzodiazepines (36%), 2 on antipsychotics (14%). At last known follow-up, ranging from 3 to 12 months from time of diagnosis, all 14 patients had a positive response with decreased frequency and duration of episodes, with 4 patients experiencing complete remission. 2 patients experienced side effects with Propranolol; thus treatment was changed to Prazosin. Most common dosages included: Propranolol 10 mg TID, Prazosin 1 mg QHS, and Clonidine 0.1 mg QHS.

Conclusions CONCLUSIONS: Adrenergic modulation of PNES associated with post-traumatic events showed a beneficial effect in reducing psychogenic nonepileptic seizures.

Authors/Disclosures
Anupama Kale, MD (DENT Neurologic Institute) PRESENTER	No disclosure on file
David V. Lardizabal, MD, FAAN (Charleston Area Medical Center)	Dr. Lardizabal has nothing to disclose.
	No disclosure on file
	No disclosure on file
Arpit Aggarwal (University of Missouri)	No disclosure on file
Pradeep K. Sahota, MD, FAAN	The institution of Dr. Sahota has received research support from VA Merit award.
Volker A. Knappertz, MD (Lacum Neurology)	Dr. Knappertz has received personal compensation for serving as an employee of Noema Pharmaceuticals . Dr. Knappertz has received personal compensation in the range of $50,000-$99,999 for serving as an officer or member of the Board of Directors for Sutura Pharmaceutical . Dr. Knappertz has received intellectual property interests from a discovery or technology relating to health care.

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