Psychogenic Seizure Diagnosis Often Delayed in U.S. Veterans

Delayed psychogenic nonepileptic-seizure diagnosis linked to cumulative antiepileptic treatment

WEDNESDAY, Sept. 7 (HealthDay News) -- Compared to civilians, U.S. veterans suffer a substantial delay in the diagnosis of psychogenic nonepileptic seizures (PNES), which is associated with greater cumulative antiepileptic drug (AED) treatment, according to a study published in the Sept. 6 issue of Neurology.

Martin Salinsky, M.D., from the Oregon Health & Sciences University in Portland, and colleagues investigated the time delay to diagnosis of PNES, the frequency of PNES, and cumulative AED treatment in 50 U.S. veterans with PNES evaluated at an epilepsy monitoring unit (EMU), and they compared the results with that of 50 civilians with PNES evaluated at the same EMU. The participants were identified from the records of 203 veterans and 726 civilians from the university affiliate admitted over a 10-year interval in a U.S. Veterans Affairs Medical Center EMU. The percentage of individuals with PNES was calculated for each group. The two groups were compared for interval from onset of the habitual spells to PNES diagnosis, cumulative AED treatment, and other measures.

The investigators found that 25 percent of the veterans and 26 percent of civilians admitted to the EMU had PNES. The delay from onset of spells to EMU diagnosis was an average 60.5 and 12.5 months for the veterans and civilians, respectively. Cumulative AED treatment was four-fold higher for veterans than civilians with PNES. Seizures were thought to be related to traumatic brain injury in 58 percent of the veterans with PNES.

"The results indicate a substantial delay in the diagnosis of PNES in veterans as compared to civilians. The delay is associated with greater cumulative AED treatment," the authors write.

Several authors disclosed financial ties to the pharmaceutical, medical device, and medical journal industries.

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