To evaluate outcomes after Epilepsy Monitoring Unit (EMU) discharge in patients diagnosed with psychogenic nonepileptic seizures (PNES) compared to those diagnosed with epileptic seizures (ES), and to identify gaps in care.

Inpatient video-EEG is often used in the diagnostic evaluation of paroxysmal events.  A proportion are ultimately diagnosed with PNES and referred to outpatient psychotherapy.  In recent years our epilepsy center has worked to improve access to outpatient psychotherapy. 

This retrospective study included 100 consecutive adult patients discharged from the EMU. Patients admitted for invasive monitoring were excluded.  Clinical variables including purpose of admission, discharge diagnosis, completion of follow-up plan, and unplanned seizure-related emergency department (ED) visits and readmissions were recorded and analyzed.

Overall, 42% of patients were diagnosed with ES, 34% with PNES, 3% with both ES and PNES, 4% with physiologic non-epileptic events, and 17% of evaluations were inconclusive.  Antiseizure medications were changed or doses adjusted in 58% of patients.  The follow-up plan was completed in 66% of patients (52% of PNES vs. 90% of ES patients).  The most common follow-up plan in PNES patients was outpatient psychotherapy, and patients were given appointments with a clinical psychologist a median of 21 days post EMU discharge.  Most common health-system-related gap in care was lack of insurance coverage.  In the first 90 days after EMU discharge, 9% of patients had an unplanned seizure-related ED visit or readmission, 19% of those with ES and 3% of those with PNES.  Median duration of follow-up was 212 days. 

Seizure-related ED visits and readmissions occurred more commonly in patients with ES compared to PNES.  While PNES was a common discharge diagnosis after inpatient video-EEG monitoring, only 52% of patients returned for follow-up, compared to 90% of patients with ES.  Efforts should focus on identifying and addressing barriers to follow-up in patients with PNES.