Medical Bracelets for Psychogenic Non-Epileptic Events?

Could wearing a bracelet or necklace indicating that someone has psychogenic non-epileptic events (PNEE) (also known as psychogenic non-epiletpic seizures, PNES) prevent unnecessary treatment, complications, and costs? Formerly known as “pseudoseizures,” PNEE are common and are present in about 20% of all people referred to epilepsy centers. Further, people with PNEE carry the wrong diagnosis of seizures for 7-19 years before receiving the correct diagnosis.

What can happen if psychogenic non-epileptic events are not recognized?

Much like epileptic seizures, PNEE can happen anytime or anywhere and can look very similar to epileptic seizures to the untrained eye. First responders and EMS personnel do an outstanding job recognizing and handling people experiencing seizures. However, acute medical treatment of epileptic seizures is vastly different than that of PNEE.

Failure to recognize PNEE can result in inappropriate, expensive, and potentially harmful treatment. There are several reported cases of individuals with known PNEE who either suffered serious complications, were intubated, or even died as a result of misdiagnosis and treatment.

Additionally, PNEE make up a significant proportion of seizure presentations to the emergency department, and these patients are often in and out of the emergency department. Health-care costs associated with PNEE in the United States is estimated to be between $2.5-10 billion dollars annually, and averages around $6,800 per hospital visit per person.

How can a medical ID help?

By having a medical ID bracelet or necklace, people with PNEE could be recognized in the field and appropriate measures could be taken. While it can vary on an individual basis, typical measures involve reassurance and emotional support rather than medication and intervention.

Avoiding unnecessary emergency department visits and hospitalizations could reduce health care demands and associated costs. Furthermore, if ID bracelets for PNEE became widely accepted, it could serve to increase awareness amongst the general population and hopefully diminish the stigma associated with this legitimate condition.

What are the potential drawbacks of a medical ID for PNEE?

Of course, a medical ID for PNEE does not come without its own host of problems. Hickam’s dictum states, "A man can have as many diseases as he damn well pleases." Approximately 10-15% of people with PNEE have a coexisting diagnosis of epilepsy. That means they have both non-epilepsy seizures and epilepsy seizures. Additionally, physically “tagging” someone with a psychiatric condition may reinforce discrimination towards or stigma associated with “psychogenic” seizures.

Who should consider a medical ID for PNEE?

In order for it to work safely, at least the following criteria would need to be met prior to considering wearing a bracelet:

• A diagnosis of PNEE must be confirmed by EEG-video monitoring or an experienced epilepsy center.
• Epilepsy seizures need to be confidently ruled out.
• Bracelet should be accompanied by some form of information to instruct responders what to do in the event of a “seizure.”
• Based off the above, the physician and health care team must still exercise their clinical judgement in deciding how to treat seizure activity in this individual.

In the end, this bracelet is not intended to ward off medical attention or discourage people from seeking effective psychiatric treatment. Rather, it should serve to avoid repeated costly and potentially harmful interventions, such as imaging (CT, MRI), IV, intubation, etc.