Abstract Details

Title Characteristics of Patients Intubated for Psychogenic Non-epileptic Seizures

Topic General Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-072

Objective This study described characteristics and outcomes of intubated psychogenic non-epileptic seizures patients.

Background Patients with psychogenic non-epileptic seizures (PNES) sometimes receive aggressive treatment leading to endotracheal intubation in the emergency department (ED).

Design/Methods

We retrospectively reviewed all patients with PNES as a discharge diagnosis who underwent continuous electroencephalography (cEEG) monitoring at Henry Ford Hospital between January 2012 and October 2017. Demographics, clinical presentation and treatments in the ED, and cEEG reports were compared between PNES patients who were intubated and those who were not.

Results Of 1,735 patients who underwent cEEG monitoring, 144 patients had PNES as a principal diagnosis. Twenty-four of these patients (17%) were intubated. Compared with non-intubated patients, intubated PNES patients were more likely to be white (91% vs 63%, P = 0.01), have lower admission Glasgow Coma Scale scores (12 [interquartile range, IQR 11-15] vs 15 [IQR 15-15], P < 0.001), have convulsive symptoms in the ED (100% vs 76%, P = 0.004), and have longer seizure duration in the ED (12 [IQR 2-49] vs 2 [IQR 1-7] minutes, P = 0.044), In addition, intubated PNES patients were more frequently diagnosed as status epilepticus (88% vs 8%, P < 0.001), treated with multiple antiepileptic drugs (AEDs, 2 [IQR 1-3] vs 1 [IQR 1-2], P = 0.001) and continuous infusion AEDs (CIV-AEDs, 55% vs 9%, P < 0.001), and received higher dose of benzodiazepines (30 [IQR 18-44] vs 10 [IQR 5-20] mg of diazepam equivalents, P = 0.001). There was no mortality; the rate of re-hospitalization within 30 days was substantially higher in intubated PNES patients (21% vs 5%, P = 0.02).

Conclusions Seventeen percent of PNES patients were intubated, and these patients have a high rate of re-hospitalization. Prolonged seizure duration, depressed level of consciousness, and aggressive treatment with benzodiazepines place PNES patients at risk for unnecessary intubation.

Authors/Disclosures
Stephan A. Mayer, MD (Henry Ford Hospital) PRESENTER	Dr. Mayer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Mayer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Phagenesis. Dr. Mayer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for ISchemaView. Dr. Mayer has stock in Neuroptics. Dr. Mayer has received publishing royalties from a publication relating to health care.
	No disclosure on file
	No disclosure on file
Gamaleldin M. Osman, MD (Mayo Clinic)	Dr. Osman has nothing to disclose.
Panayiotis N. Varelas, MD, PhD, FAAN (Albany Med-Department of Neurology)	Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Astra Zeneca -Alexion - Portola. Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Annexon. Dr. Varelas has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Astra Zeneca- Alexion-Portola. Dr. Varelas has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Marinus. Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Annexon. Dr. Varelas has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Giammarco, Mullins & Horton P.C. The institution of Dr. Varelas has received research support from Marinus. The institution of Dr. Varelas has received research support from Bayer. Dr. Varelas has received publishing royalties from a publication relating to health care. An immediate family member of Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Rep to the RUC meeting with AAN. Dr. Varelas has received personal compensation in the range of $500-$4,999 for serving as a Speaker at the Annual Meeting with AAN. Dr. Varelas has a non-compensated relationship as a President - Past President with Neurocritical Care Society that is relevant to AAN interests or activities.
	No disclosure on file

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