A multisite controlled study of risk factors in pediatric psychogenic nonepileptic seizures

Abstract

SUMMARYObjective: Psychogenic nonepileptic seizures (PNES) in youth are symptoms of a difficult to diagnose and treat conversion disorder. PNES is associated with high medical and psychiatric morbidity, but specific PNES risk factors in the pediatric population are not known. We examined if youth with PNES have a distinct biopsychosocial risk factor profile compared to their siblings and if the interrelationships between these risk factors differentiate the PNES probands from the sibling group. Methods: This multisite study included 55 youth with a confirmed diagnosis of PNES (age range 8.6-18.4 years) and their 35 sibling controls (age range 8.6-18.1 years). A video EEG and psychiatric assessment confirmed the PNES diagnosis. Parents reported on each child's past and present medical/epilepsy, psychiatric, family, and educational history. Each child underwent a structured psychiatric interview, standardized cognitive and academic achievement testing, and completed self-report coping, daily stress, adversities, and parental bonding questionnaires. Results: Compared to their siblings, the PNES probands had significantly more lifetime comorbid medical, neurological (including epilepsy), and psychiatric problems; used more medications and intensive medical services; had more higher anxiety sensitivity, practiced solitary emotional coping, and experienced more lifetime adversities. A principal components analysis of these variables identified a somatopsychiatric, adversity, epilepsy, and cognitive component. The somatopsychiatric and adversity components differentiated the probands from the siblings, and were highly significant predictors of PNES with odds ratios of 15.1 (95% CI [3.4, 67.3], and 9.5 (95% CI [2.0, 45.7]), respectively. The epilepsy and cognitive components did not differentiate between the PNES and sibling groups. Significance: These findings highlight the complex biopsychosocial and distinct vulnerability profile of pediatric PNES. They also underscore the need for screening the interrelated risk factors included in the somatopsychiatric and adversity components and subsequent mental health referral for confirmation of the diagnosis and treatment of youth with PNES.

A Therapeutic Approach to Psychogenic Nonepileptic Seizures

“…School-related problems and interpersonal/family problems are commonly reported underlying stressors [56]. Physical and sexual abuse are believed to be common, but one recent study found no statistical difference in frequency of abuse between children with PNES and controls [57]. Chronic medical illness was found to be common compared to controls [57].…”

Psykogene ikke-epileptiske anfall hos barn

“…Blant ungdom og voksne med tilstanden er 70 -80 % kvinner (4,19,20). Kjønnsfor-skjellen er ikke så uttalt blant barn (18).…”

“…Oppvekst i en dysfunksjonell familie, faglige vansker på skolen, mobbing eller andre problemer i kameratflokken er hyppig assosiert med tilstanden hos barn (4,22). Fysisk eller seksuelt misbruk er ikke like vanlig blant barn med slike anfall som hos voksne (23), selv om en studie viste at 21 % og 6 % hadde opplevd henholdsvis seksuelt eller fysisk misbruk (3).…”

“…Man antar at psykogene ikke-epileptiske anfall hovedsakelig er et symptom på en konversjonslidelse (3,4). I diagnoseklassifikasjonssystemene DSM-5 og ICD-10 blir tilstanden kategorisert som henholdsvis en konversjons-og dissosiasjonstilstand.…”

“…Barna er ofte gjenstand for gjentatte akuttinnleggelser og mange unødvendige undersøkelser. Mange får dessuten etter hvert et stort forbruk av lite virksomme legemidler (4).…”