Psychogenic nonepileptic seizures (PNES) are paroxysmal events, not caused by ictal epileptiform activity. PNES is strongly associated with post-traumatic stress disorder (PTSD). Treatment efficacy of PNES remains controversial, however it has been proposed that both psychotherapy and pharmacotherapy cause a reduction in seizure frequency and healthcare utilization.

The objective of this study was to explore access of veterans to mental health therapies prior to the diagnosis of PNES.

This is a longitudinal, retrospective study of healthcare records of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) veterans using the VA healthcare system, diagnosed with PNES through video electroencephalogram (vEEG) from 2003-2016. Chi-squared analyses were conducted between covariates.

Of the 371 veterans were included in this cohort, 308 (83%) were male, and the average age at first PNES episode was 34. In the year prior to diagnosis, 212 (57%) experienced >30 episodes, prompting at least one emergency room visit in 89 (24%), and at least one hospital admission in 91 (25%).  Psychotherapy was performed in 160 (43%), of which 139 (87%) were diagnosed with PTSD. Psychotherapy was most frequently individual (136 (85%)), supportive therapy (138 (86%)), with 97 (61%) veterans undergoing <20 therapy sessions and 40 (25%) undergoing >20. Seizure burden was not associated with the utilization of psychotherapy (p=0.067), however seizure burden was associated with PTSD (0.0001). Pharmacotherapy in the form of anti-seizure drugs (ASDs) were utilized in 288 (78%), including ASDs with known mood stabilizing properties; Valproate 72 (5%), Lamotrigine 191 (66%), Carbamazepine 80 (28%), and Oxcarbazepine 43 (15%).

Preliminary analysis suggests most veterans with PNES received psychotherapy for PTSD prior to diagnosis and yet continued to suffer from PNES. This may imply that although PTSD and PNES may exist concomitantly, PNES requires a separate and specific treatment modality.