To implement a standardized approach to the initial management of functional seizures (FS)/psychogenic non-epileptic events (PNEE) in the Epilepsy Monitoring Unit (EMU).

FS/PNEE is a functional neurological disorder characterized by events resembling epileptic seizures without electrographic correlate, representing up to 40% of diagnoses in the EMU.  The initial stage after diagnosis may represent a critical period that can affect long-term prognosis.  We implemented a standardized approach to disclosing diagnosis and coordinating psychological intervention in newly diagnosed FS/PNEE.

We followed patients diagnosed with FS/PNEE in the EMU at the Hospital of the University of Pennsylvania. The pre-intervention group (n = 17, admitted May-November 2022) received care according to standard practice. The post-intervention group (n = 24, admitted November 2022-May 2023) received (1) standardized disclosure of diagnosis, (2) inpatient psychiatry consult, and (3) follow-up phone call to coordinate outpatient psychology visit. Primary outcome was reduction in event frequency measured at a three-month neurology follow-up visit.

Among patients who attended the neurology follow-up visit (66%), event frequency significantly decreased after EMU admission in both groups (overall, pre-EMU median (IQR): 30.0 (4.0-30.0) events/month, post-EMU: 3.5 (1.0-10.0), T⁺ = 173.5, p = 0.002). There was no difference in reduction in event frequency between the pre- and post-intervention groups (p = 0.96). Half of patients in the post-intervention group had not scheduled psychology follow-up by the time of their neurology visit. Reasons cited for lack of psychology follow up included (1) Did not know how to arrange, (2) Insurance/financial issues, and (3) Long wait time.

Patients with FS/PNEE have fewer events after their diagnosis is disclosed in the EMU. There was no clear benefit from a standardized approach to disclosing diagnosis and coordinating psychological intervention. Limitations include sample size, loss to follow-up, and interval of follow-up.