Responsive neurostimulation device use in patients with epilepsy and psychogenic non-epileptic events. Case report and Healthcare expenditure analysis related to neuromodulation therapy in Epilepsy patients
Ahmad Sawalha1, Christopher Anderson1, Chad Carlson2
1Medical College of Wisconsin, 2Froedtert & Medical College of Wisconsin
Objective:
To analyze the utilization of intracranial recording of electrocorticogram (Ecog) using Responsive Neurostimulation (RNS) to differentiate epileptic seizures from nonepileptic events and its utility to reduce the financial burden on the healthcare system.
Background:
Around 30% of the patients referred to tertiary care epilepsy centers for treatment resistant epilepsy have a diagnosis of psychogenic non-epileptic events (PNEE) and 27% of PNEE patients were incorrectly admitted to the ICU for status epilepticus management causing significant financial burden on the healthcare system. The coincidence of epilepsy and PNEE is around 10% making it challenging to manage clinical events conservatively without risking missing an epileptic seizure.
Design/Methods:
We obtained the healthcare records for a patient who has a dual diagnosis of epilepsy and PNEE. We reviewed the data and Ecogs from the RNS device. We compared the cost of healthcare before and after RNS placement that are related to seizures management or characterization of clinical events including the cost of RNS placement, hospital admissions, hours of EEG recording, and imaging studies.
Results:
The RNS decreased the number of admissions and total healthcare expenditure by using the data generated by RNS remotely to characterize the patient’s clinical events. After RNS implantation, the number of admissions related to epilepsy management decreased to “zero” and the number of hours spent to review EEG for triaging her clinical events decreased from 528 hours to 8 hours only. This resulted in successful weaning off multiple anti-seizure medications and better quality of life. The total cost of care related to epilepsy management was reduced from 116,517 $ to 921 $ after RNS implantation.
Conclusions:
Treatment with RNS in our patient with both diagnoses of epilepsy and PNEE lead to reduction in healthcare expenditure for psychogenic non-epileptic events specifically in addition to its benefit in reducing the frequency of epileptic seizures.