Characteristics of patients intubated for psychogenic non-epileptic seizures
Mayer S, Viarasilpa T, Panyavachiraporn N, Osman G, Varelas P, and Akioyamen N. Characteristics of patients intubated for psychogenic non-epileptic seizures. Neurology 2019; 92(15).
Objective: This study described characteristics and outcomes of intubated psychogenic nonepileptic seizures patients. Background: Patients with psychogenic non-epileptic seizures (PNES) sometimes receive aggressive treatment leading to endotracheal intubation in the emergency department (ED). Design/Methods: We retrospectively reviewed all patients with PNES as a discharge diagnosis who underwent continuous electroencephalography (cEEG) monitoring at Henry Ford Hospital between January 2012 and October 2017. Demographics, clinical presentation and treatments in the ED, and cEEG reports were compared between PNES patients who were intubated and those who were not. Results: Of 1,735 patients who underwent cEEG monitoring, 144 patients had PNES as a principal diagnosis. Twenty-four of these patients (17%) were intubated. Compared with nonintubated patients, intubated PNES patients were more likely to be white (91% vs 63%, P = 0.01), have lower admission Glasgow Coma Scale scores (12 [interquartile range, IQR 11-15] vs 15 [IQR 15-15], P < 0.001), have convulsive symptoms in the ED (100% vs 76%, P = 0.004), and have longer seizure duration in the ED (12 [IQR 2-49] vs 2 [IQR 1-7] minutes, P = 0.044), In addition, intubated PNES patients were more frequently diagnosed as status epilepticus (88% vs 8%, P < 0.001), treated with multiple antiepileptic drugs (AEDs, 2 [IQR 1-3] vs 1 [IQR 1-2], P = 0.001) and continuous infusion AEDs (CIV-AEDs, 55% vs 9%, P < 0.001), and received higher dose of benzodiazepines (30 [IQR 18-44] vs 10 [IQR 5-20] mg of diazepam equivalents, P = 0.001). There was no mortality; the rate of re-hospitalization within 30 days was substantially higher in intubated PNES patients (21% vs 5%, P = 0.02). Conclusions: Seventeen percent of PNES patients were intubated, and these patients have a high rate of re-hospitalization. Prolonged seizure duration, depressed level of consciousness, and aggressive treatment with benzodiazepines place PNES patients at risk for unnecessary intubation.