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- Categorized in: 2013 Compendium of Federal Medicine
Patients are referred to an epilepsy center and an epileptologist for many reasons, usually after experiencing seizures or spells with uncertain etiology. Often, patients have been diagnosed as having epilepsy by a primary-care physician, psychiatrist or general neurologist, and antiepileptic drugs (AEDs) have been used unsuccessfully to control these seizures. In some instances, patients may have taken AEDs for years or decades before being referred to epilepsy center for “seizure (or spell) characterization.”
Characterization helps determine if the patient’s spell episodes are due to an epileptic disorder or other etiology. If the seizures are found to be epileptic, treatment with appropriate AED or surgery is considered. If the seizures are nonepileptic, they can be either physiologic no-nepileptic seizures or PNES. Physiologic nonepileptic seizures are spells that may occur due to a sleep disorder, cardiac arrhythmia or other such medical condition. PNES are much more common, and often occur with depression, anxiety disorder (such as PTSD), or other mental health disorder.
Life with Seizures
The diagnosis of epilepsy carries with it a need for potentially lifelong therapy with AEDs, but also brings a list of psychosocial limitations. Foremost among these is the restriction from driving. This leads to confinement if public transportation is not available, few employment options and social isolation. All these combined result in more limited medical care due to accessibility challenges. When patients with epilepsy find employment, they are dismissed if they have a seizure at work, as they are considered a liability to themselves and their place of work. Therefore, many patients with epilepsy seek disability assistance. The assessment and treatment by epileptologists and relevant resources often result in successful treatment of seizures, frequently removing some social obstacles to leading productive lives.
Unfortunately, when restrictions for epilepsy patients are imposed erroneously, such as on patients with PNES who are misdiagnosed as having epilepsy, the complications can be devastating. Not only are they subject to same restrictions as patients with epilepsy, they also are burdened by their underlying diagnosis and its restrictions (such as TBI or PTSD). Many of these patients have received disability and other benefits usually reserved for epilepsy patients. When they are correctly diagnosed, their treatment is complicated further because their disability assessments likely were based incorrectly on having epilepsy.
The best way to minimize these complications in PNES is to diagnosis early and avoid years of erroneous treatment for epilepsy. In the VA, this can be accomplished by an ECoE Network to which referrals from other VA hospitals are facilitated.
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