What interventions have you found most effective for reducing ED utilization in patients with PNES?

I have a frank discussion regarding the difference between epilepsy and PNES and the differing modes of treatment. I also refer them to our behavioral health department for cognitive behavioral therapy. That seems to decrease their ER visits.

I give them/the family indications on when they should and shouldn't come to the ED.

If the history and prior workup have found no concern for concurrent epileptic events, there's really no reason for them to be coming to the ED at all.

I also walk them through the process of what will likely happen on a repeat visit, the expected duration of the visit, and the availability of diagnostics depending on the time of presentation (like whether there's an EEG tech available).