Managing Functional Neurological Disorders: Protocol of a Cohort Study on Psychogenic Non-Epileptic Seizures Study

Figures & data

Figure 1 Path analysis of direct and indirect risk facts that may lead to PNES.

Figure 2 Models of Coordinating Neuro-Psych Care. (A) Center of Excellence Model hires a mental health provider within the epilepsy program; (B) mental health integration into primary care, this is the most popular model; (C) mental health is sometimes formally integrated in neurology at a departmental level; (D) tele-mental health models allow for mental health professionals to provide services remotely; (E) Mental health providers may develop informal relationship and develop a professional interest in epilepsy care; (F) many neurologists refer to out of network mental health providers.

Abbreviations: N, Neurologist; M, Mental Health-Care Provider; P, Primary Care Provider.

Table 1 Inclusion and Exclusion Criteria for the Selection of PNES Patients

Inclusion Criteria	Exclusion Criteria
Post-9/11 veterans	No documented EEG
Enrolled in the VA with at least 3 years of care (at least one healthcare visit each year for 3 years)	PNES was not documented as a differential diagnosis
ICD-9 (informatics tool to identify as there is no code) and ICD-10 (F44.5) diagnostic coding	Seizures due to physiological problem (alcohol withdrawal, syncope, substance abuse)
Documentation of the following: pseudo-seizures, psychogenic seizures, stress-related seizures, anxiety-related seizures

Figure 3 Selection of participants from the national VA database.

Table 2 Description of Data Sources

Data Sources	Description
VA/DOD OEF/OIF/OND Roster	This file contains demographic and military service data for all service members deployed in support of OEF/OIF/OND including information regarding the first deployment start and end dates and last deployment start and end dates.
VA CDW	See Table 3 for specifics (clinical and administrative health care data)
TBI Screen and Comprehensive TBI Evaluation	Contained in CDW files
DoD Military Health System Data Repository	We will obtain the Military Health System Data repository. Data includes inpatient, outpatient, and pharmacy data similar to those in the VA and can be linked by social security number.
DoD Trauma Registry (DoDTR)	DoD database containing medical trauma record data elements (e.g., mechanism of injury, ICD-9-CM codes, Abbreviated Injury Score, CPT4 codes, etc.) from military levels of care I (first responder) through level V (definitive care both in and outside the continental United States).

Abbreviations: VA, Veterans Affairs; DOD, Department of Defense; OEF, Operation Enduring Freedom; OIF, Operation Iraqi Freedom; OND, Operation New Dawn; TBI, Traumatic Brain Injury; CDW, Corporate Data Warehouse; CPT, Current Procedural Terminology; ICD, International Classifications of Diseases.

Table 3 Further Details on the Data from the VA’s Corporate Data Warehouse Files

Variables	Source(s)
Demographics: Date of Birth (DOB), race/ethnicity, sex, home zip code, service connected status	Corporate data warehouse (CDW) Patient files
Medical and psychiatric conditions: muscular skeletal disorders (MSD), Post traumatic Stress Disorder (PTSD), depression, substance use disorder, etc.	CDW Visit files
Consults, referrals	CDW consults
Visits, utilization	CDW/Decision Support Services (DSS) – fee basis, utilization, stop codes
Medications	CDW – Pharmacy files (RXOutpatFill, RxOutpat, RxOutpatSig), Non-VA Meds
Station, VISN facility size, geographic location	CDW – Patient files
Smoking, alcohol, PTSD, and depression screen Results	CDW – Health Factors, Mental Health, psych instruments
Progress notes, primary care provider Information	CDW – primary care management module (PCMM), progress notes
Non-VA care	Fee basis, VA Choice tables
Pain scores	Vital Signs

Abbreviations: CDW, Corporate Data Warehouse; VISN, Veterans Integrated Services Networks; PTSD, Post-Traumatic Stress Disorder; VA, Veterans Affairs.