Managing functional neurological disorders: Protocol of a cohort study on psychogenic non-epileptic seizures study

Hamada Hamid Altalib, Daniela Galluzzo, Stephanie Argraves, Joseph Goulet, Yarden Bornovski, Kei Hoi Cheung, Ebony Jackson-Shaheed, Benjamin Tolchin, Brenda T. Fenton, Mary Jo Pugh

Research output: Contribution to journalArticle

Abstract

Background: Functional neurological disorders (FNDs) are neurological symptoms that cannot be explained by an underlying neurological lesion or other medical illness and that do not have clear neuropathological correlates. Psychogenic non-epileptic seizures (PNES) are a common and highly disabling form of FND, characterized by paroxysmal episodes of involuntary movements and altered consciousness that can appear clinically similar to epileptic seizures. PNES are unique among FNDs in that they are diagnosed by video electroencephalo-graphic (VEEG), a well-established biomarker for the disorder. The course of illness and response to treatment of PNES remain controversial. This study aims to describe the epidemiology of PNES in the Department of Veterans Affairs Healthcare System (VA), evaluate outcomes of veterans offered different treatments, and compare models of care for PNES. Methods: This electronic health record (EHR) cohort study utilizes an informatics search tool and a natural language processing algorithm to identify cases of PNES nationally. We will use VA inpatient, outpatient, pharmacy, and chart abstraction data across all 170 medical centers to identify cases in fiscal years 2002–2018. Outcome measurements such as seizure frequency, emergency room visits, hospital admissions, suicide-related behavior, and the utilization of psychotherapy prior to and after PNES diagnosis will be used to assess the effectiveness of models of care. Discussion: This study will describe the risk factors and course of treatment of a large cohort of people with PNES. Since PNES are cared for by a variety of different modalities, treatment orientations, and models of care, effectiveness outcomes such as seizure outcomes and utilization of emergency visits for seizures will be assessed. Outcome measurements such as seizure frequency, emergency room visits, hospital admissions, suicide-related behavior, and psychotherapy prior to and after PNES diagnosis will be used to assess the effectiveness of models of care.

Original languageEnglish (US)
Pages (from-to)3557-3568
Number of pages12
JournalNeuropsychiatric Disease and Treatment
Volume15
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

Keywords

  • EHR
  • Electronic health record
  • FND
  • Functional neurological disorders
  • PNES
  • Psychogenic nonepileptic seizures
  • VA
  • Veterans administration

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

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  • Cite this

    Altalib, H. H., Galluzzo, D., Argraves, S., Goulet, J., Bornovski, Y., Cheung, K. H., Jackson-Shaheed, E., Tolchin, B., Fenton, B. T., & Pugh, M. J. (2019). Managing functional neurological disorders: Protocol of a cohort study on psychogenic non-epileptic seizures study. Neuropsychiatric Disease and Treatment, 15, 3557-3568. https://doi.org/10.2147/NDT.S234852