Epileptic and psychogenic nonepileptic seizures (PNES) may look similar, but actually have different causes and treatments. Up to 20 percent of patients diagnosed with epilepsy actually have PNES, which are not treated by antiepileptic drugs (AEDs). According to a new study by Rhode Island Hospital researcher W. Curt LaFrance Jr., M.D., M.P.H., director of neuropsychiatry and behavioral neurology, increasing access to video electroencephalography (video-EEG) may aid in distinguishing between epilepsy and PNES. The study is published online in advance of print in the journal Epilepsy & Behavior.
This is the first study to compare how clinicians diagnose and treat PNES in a North American country and a South American country, and underscores the importance of access to video-EEG to conclusively make the diagnosis of PNES. It compared diagnosis and treatment practices among clinicians in the U.S. and Chile who treat epilepsy and PNES to assess standard medical care for PNES.
In the U.S., 89 percent of clinician respondents reported using inpatient video-EEG to diagnosis PNES, which is the gold standard for diagnosis. However, this diagnostic tool is not always available in other parts of the world. Video-EEG has been used in Chile for more than two decades, but is not easily accessible in many parts of the country, and 25 percent of respondents in Chile used inpatient video-EEG. Video-EEG is more readily available in the U.S., with 95 percent of respondents having access, compared to 40 percent of the respondents from Chile having access.
"Video-EEG monitoring or ambulatory EEG with video can capture the brainwaves along with a video of the patient's seizure, which, when reviewed together greatly helps make the proper diagnosis," LaFrance said. "Relying on just the patient history or seizure description may lead to an incorrect diagnosis, and subsequently, inappropriate treatment."