Abstract Details

Title Predictors of Emergency Care Utilization in Veterans with Psychogenic Nonepileptic Seizures (PNES)

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 11-004

Objective To identify predictors of emergency care utilization among Veterans with PNES.

Background Veterans with psychogenic nonepileptic seizures (PNES) often present to emergency departments (ED) due to diagnostic uncertainty and complex medical and psychiatric comorbidities. System-level factors within the Veterans Affairs (VA) facilities may further influence acute care utilization, yet the determinants of ED use that contribute to high healthcare utilization and cost burden remain poorly understood.

Design/Methods A retrospective analysis of Veterans with PNES confirmed by video-EEG across 129 VA epilepsy facilities. The primary outcome was the total number of ED visits occurring within five years post-diagnosis. Negative binomial regression was used after confirming overdispersion. Predictors included demographic factors, seizure frequency, psychiatric history, comorbid conditions, and psychotropic medication. Incidence rate ratios (IRRs) with 95% confidence intervals were estimated.

Results Among 1,175 Veterans, 70% had no ED visits during the five-year follow-up period. The mean age was 52.6 years, and 40% (n=468) were female. Among those with ≥1 visits (30%, n=359), utilization was right-skewed (median: 2; [IQR 1-3.5]; mean: 3.32). Prior psychiatric hospitalization was the strongest predictor, nearly doubling ED visit rates (IRR = 1.95, 95% CI 1.27–3.02, p = 0.001). Depression (IRR = 1.42, 95% CI 1.04–1.95, p = 0.03) and sedative/hypnotic use (IRR = 1.37, 95% CI 1.00–1.90, p = 0.05) were also associated with increased utilization. Conversely, PTSD was associated with lower ED use (IRR = 0.68, 95% CI 0.50–0.92, p = 0.009).

Conclusions Psychiatric history, particularly prior hospitalization, strongly predicts ED utilization among Veterans with PNES. These findings highlight the need for interventions to better integrate and coordinate mental health care within PNES care pathways. Future studies should examine whether early psychiatric interventions reduce emergency care burden.

Authors/Disclosures
Saifeldin Hossameldin, MD PRESENTER	Dr. Hossameldin has nothing to disclose.
Poojith Nuthalapati, MD	Mr. Nuthalapati has nothing to disclose.
Margaret Gopaul, PhD (Yale School of Medicine)	Dr. Gopaul has nothing to disclose.
Hamada H. Altalib, DO (VA Connecticut Healthcare System)	The institution of Dr. Altalib has received research support from UCB. The institution of Dr. Altalib has received research support from DEPARTMENT OF DEFENSE - CONGRESSIONALLY DIRECTED MEDICAL RESEARCH PROGRAMS.

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