Emergency Department for Seizure Management

Dissertation Committee Chair: Henry Kaminski, MD

March 17, 2023, 11:00 a.m. (EST)

Psychogenic non-epileptic seizures (PNES) mimic epilepsy but are not associated with an abnormal electrical discharge on the electroencephalogram. PNES is associated with a range of atypical neuropsychological responses to emotional distress, physiological stressors, trauma, or abuse. Since PNES mimics epileptic seizures, when patients first present to a hospital, the neurologist examines them in an Epilepsy Monitoring Unit before making a diagnosis. Since PNES mimics epilepsy, they are often treated and managed as epileptic attacks until differentiation is made. This leaves patients confused and often wondering if they have unmanageable epilepsy. As such, seizures are a common reason for visiting the emergency department (ED) and are often more common among patients without access to ambulatory care. There is growing evidence highlighting disparities in seizure care in the ED, related to race, ethnicity, and socioeconomic status (SES) in general. PNES is a significant burden to the patient and society because of the enormous annual costs, spent on ER visits, inpatient monitoring, and clinic visits, among others. Optimal control of PNES is achieved through consistent outpatient management. However, this is difficult to achieve in uninsured patients and those with a lack of understanding of the diagnosis and access to outpatient ambulatory care, which is a significant factor of disparity in care. The major consequence of poor seizure management is the frequent use of the ED for seizure care. My goal was to identify if there are certain racial, ethnic, or social characteristics of patients presenting to the ED with seizures, if these characteristics among PNES patients differ from those with epilepsy, and if any of these characteristics serve as determinants for repeat ED visits for seizure care.