The diagnosis of psychogenic nonepileptic seizures (PNES) can only be made with EEG-video monitoring. The authors describe a provocative technique without placebo. Patients with a clinical suspicion for PNES underwent an activation procedure using suggestion, hyperventilation, and photic stimulation. Of 19 inductions performed, 16 (84%) were successful in inducing the habitual episode. The authors' technique had a sensitivity comparable to those using placebo (e.g., saline injection), but does not have disadvantages.

BACKGROUND Transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC) has been associated with improved long-term dysphagia symptomatology as compared to chemoradiation. Dysphagia in the perioperative period has been inadequately characterized. The objective of this study is to characterize short-term swallowing outcomes after TORS for OPSCC. METHODS Patients undergoing TORS for OPSCC were prospectively enrolled. The Eating Assessment Tool 10 (EAT-10) was used as a measure of swallowing dysfunction (score > 2) and was administered on post-operative day (POD) 1, POD7, and POD30. Patient demographics, weight, pain level and clinical outcomes were recorded prospectively focused on time to oral diet, feeding tube placement and dysphagia-related readmissions. RESULTS 51 patients were included with pathologic T-stages of T1 (24), T2 (20), T3 (3), Tx (4). Self-reported preoperative dysphagia was unusual (13.7%). The mean EAT-10 score on POD1 was lower than on POD7 (21.5 vs. 26.6, p=0.005) but decreased by POD30 (26.1 to 12.2, p<0.001). 47/51 (92.1%) were discharged on an oral diet but 57.4% required compensatory strategies or modification of liquid consistency. 98.0% of patients were taking an oral diet by POD30. There were no dysphagia-related readmissions. CONCLUSIONS This prospective study shows that most patients who undergo TORS experience dysphagia for at least the first month post-operatively but nearly all can be started on an oral diet. The dysphagia-associated complication profile is acceptable after TORS with a minority of patients requiring temporary feeding tube placement. Aggressive evaluation and management of postoperative dysphagia in TORS patients may help prevent dysphagia-associated readmissions.

To analyze the yield of short-term outpatient EEG video monitoring, the authors reviewed data on all patients who underwent this procedure at their center. All patients were suspected of having psychogenic nonepileptic seizures (PNES) on clinical grounds. The total number of cases of short-term outpatient EEG video monitoring was 74. In 49 (66%) cases, the suspected diagnosis of PNES could be confirmed, thereby obviating the need for prolonged inpatient EEG video monitoring.

Purpose/Objective(s): Transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC) has been associated with improved long-term dysphagia quality of life as compared to chemoradiation. Nevertheless, dysphagia is common in the perioperative period and has been inadequately characterized. Our primary objective in this study is to characterize short-term swallowing outcomes after TORS for OPSCC in a prospective manner in an attempt to improve postoperative outcomes. Materials/Methods: Patients undergoing TORS for OPSCC were prospectively enrolled into this study between the dates of June 20, 2014 and July 31, 2015. Patients were evaluated by a speech-language pathologist postoperatively for diet recommendations and swallow strengthening exercises. The Eating Assessment Tool 10 (EAT-10), a 10-item validated questionnaire measuring swallowing quality of life, was administered on postoperative day (POD) 1, POD 7, and POD 30. A score >3 is considered to be indicative of swallowing dysfunction. Medical records were queried for demographics, clinical history, staging, intraoperative factors, and postoperative course. Patients were excluded for a history of previous TORS or radiation to the oropharynx, repeat TORS within 1 month after enrollment, TORS for nonmalignancy, a procedure on a nonoropharyngeal aerodigestive subsite, a contraindication to swallowing evaluation, or incomplete data. Statistical analysis was performed using a paired t test to compare EAT-10 scores between POD 1 and POD 7 and POD 30. Results: Fifty-nine patients met initial inclusion criteria. Twenty-four patients were excluded (8 for nonoropharyngeal procedures, 5 for contraindications to swallowing evaluation, 7 for repeat TORS within 1 month, and 4 for incomplete data), leaving 35 patients (26 males, 9 females) for analysis. The mean age was 58.8 (range 43-74) years. Four of the 35 patients (11.4%) reported preoperative dysphagia. Twenty of the 35 patients (57.1%) underwent tongue base resection, with the remainder undergoing radical tonsillectomy. T stages were Tx (3), T1 (18), T2 (13), T3 (1), all HPV+. All patients were started on an oral diet by POD 1 without instrumental testing. The mean EAT-10 score (0-40) on POD 1 was 21.5 (range 0-37), on POD 7 was 27.7 (range 14-45), and on POD 30 was 11.9 (range 1-33). EAT-10 scores were significantly worse at POD 7 (PZ.003) and significantly better on POD 30 (P<.001) as compared with initial evaluation. However, at 1 month, only 5 of 34 patients (14.3%) had normal EAT-10 scores. Mean weights (lbs) decreased significantly over the month (207.6 vs 198.8, P<.001). Conclusion: Most patients who undergo TORS experience dysphagia for at least the first month after surgery. Patients can be counseled that dysphagia will worsen by postoperative day 7 and then improve, but it likely will not resolve by 1 month. Swallowing evaluation and therapy should be considered routine in this cohort of patients.