Comparing the yield and cost effectiveness of short video electroencephalogram (SVEEG) vs long video electroencephalogram (LVEEG) in diagnosis of PNES and finding out the contribution of verbal suggestion in induction of PNES.

A retrospective observational study, conducted at a tertiary hospital at northern of Jordan, included adult patients above 16 years who underwent VEEG for spell classification. VEEGs were either SVEEG done in the outpatient lab, or overnight LVEEG done in the sleep lab.

EEGs were read by American board epileptologists. The two groups were compared in terms of demographic data, comorbidities, features of epilepsy/PNES, and results of monitoring.

A total of 143 patients were included, all of them were evaluated using EEG for spell classification. 27 patients (18.8% of total cohort) were evaluated using LVEEG. 116 patients (81.1% of the total cohort) were evaluated using SVEEG.

PNES were captured in 10 out of the 27 patients (37%) who underwent LVEEG, 7 of them (70%) had typical habitual events and 3 out of them (30%) were suggestible. On the other hand, 77 patients had PNES out of the 116 patients who underwent SVEEG (66%), 62 of them (80.5%) had typical habitual events and 28 out of them (36%) were suggestible.

SVEEG costs around 200 dollars and LVEEG costs around 1000 dollars in our institution. EMU admission would cost 2000 dollars or more for a few days admission.

SVEEG is highly effective in diagnosing PNES with better time and cost effectiveness in comparison to LVEEG. We encourage its use in centers with limited resources. Verbal suggestion is highly effective in the induction of PNES.