PO217 Diagnostic, investigation and management strategies for non epileptic attack disorder

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Abstract

Purpose

Recommendations by International League Against Epilepsy (ILAE) Non-epileptic Seizures Task Force propose a four-level hierarchical approach (using history, witnessed event, electroencephalographic (EEG)) to establish Non-Epileptic Attack Disorder (NEAD) diagnosis. We describe clinical characteristics, diagnostic certainty level, investigation pathways and management strategies of patients at a specialist neuropsychiatry clinic.

Method

Medical notes of 148 patients with NEAD attending between September 2012 – 2015 were reviewed.

Results

Patient categorisation (Females: n=108, 73.0%; Disease duration: 7.9 years (SD 10.4)) was mainly based on clinical features and EEG findings; only 7 (4.7%) patients had attacks witnessed by a specialist. Largest diagnostic categories were ‘possible’ (less robust) (n=54; 36.5%), ‘clinically-established’ (moderately robust) (n=40; 27.0%), then ‘documented’ (most robust) (n=12; 8.1%), ‘probable’ (n=5; 3.4%) (moderately robust). EEG was most commonly performed (n=125; 84.4%), then neuro-imaging (MRI: n=100, 67.6%). 48 (32.4%) had further neurological/cardiac/vestibular/sleep testing. There were no differences in pharmacological/behavioural management across categories.

Conclusion

Difficulty in witnessing clinical events in person/on video recording/EEG limits clinical application of diagnostic recommendations, and thereby more robust diagnostic categorisation. Displaying video-footage in clinic could improve diagnostic certainty. Adherence to recommendations may help streamline investigation paths, reducing diagnostic delays. Irrespective of categorisation, pharmacological and behavioural interventions are implemented.

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