Outcomes of children and adolescents 1 year after being seen in a multidisciplinary psychogenic nonepileptic seizures clinic

Abstract

Objective: Psychogenic nonepileptic seizures (PNES) are paroxysmal events that may involve altered subjective experience and change in motor activity with a psychological cause. The aim of this work is to describe a population of pediatric patients with PNES and identify factors predictive of 12-month outcomes. Methods:We conducted a prospective observational study of children and adolescents referred to the multidisciplinary Nationwide Children's Hospital PNES clinic between November 2017 and July 2019. Information was collected from patients during clinic visits and semistructured follow-up phone calls. Descriptive statistics and Fisher exact test were used for analysis.Results: Of the 139 consecutive patients referred to the PNES clinic, 104 were seen in clinic and 63 answered 12-month follow-up calls. Patients with comorbid epilepsy had increased rates of participation at 12-month follow-up (p = .04). Complete remission was achieved by 32% (20/63) of patients at 12 months. Combined PNES remission and improvement was 89% (56/63) at 12 months. Patients and families who were linked with counseling at 1 month were more likely to achieve remission at 12 months (p = .005). Less than half (44%, 28/63) of patients reached at 12 months had their events documented on video-electroencephalogram (EEG) at diagnosis; however, those who did were not more likely to be accepting of the diagnosis at 12 months (p = 1.0), be linked with counseling at 12 months (p = .59), or be event-free at 12 months (p = .79).Significance: Remission occurred in one third of patients by 12 months; however, improvement in events was seen in 89%. Connection to counseling by 1 month was associated with increased remission rates at 12 months. Capturing events on video-EEG was not associated with increased acceptance or event freedom at 12 months. Diagnosis should be followed by strong encouragement to connect with counseling quickly to achieve a goal of increasing 12-month PNES remission rates.

A Disciplined Approach to Treatment of Psychogenic Nonepileptic Seizures

“…Improvement was robust, with complete remission in 32%, and at least partial reduction in episode frequency in another 57% at 12 months, for a total of 89% with notable improvement. 5 The results affirm that the intervention not only enabled successful engagement in treatment, but that the treatment benefit was widely present a year later. Such sustainability is difficult to obtain in chronic conditions.…”

“…Still, it is true that with each publication that emerges, new perspectives are appreciated, from the idea that treatment works 1 , 2 to the utility of creative methods of service delivery. 3 , 4 The study by Fredwall and colleagues 5 is no exception, and lends new insight that extends well beyond the concrete results.…”

Prospective multicenter cohort study of possible psychogenic nonepileptic seizure cases—Results at 1‐year follow‐up examinations

“…A large number of follow‐up studies regarding PNES have been published since the 1990 s and can be divided based on how the starting point was determined, as summarized in Figure 2 . While the time of diagnosis was mostly used as the starting point in the early observational studies, 16 , 19 , 20 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 more recent studies often start at the point of psychotherapeutic intervention (Figure 2 ). As for the former type, while follow‐up data were newly inquired in half of those, 16 , 19 , 23 , 25 , 32 , 33 , 35 , 36 , 38 , 42 , 45 , 49 baseline data were acquired by a retrospective examination of case records, except for a few exceptions.…”

“…As for the former type, while follow‐up data were newly inquired in half of those, 16 , 19 , 23 , 25 , 32 , 33 , 35 , 36 , 38 , 42 , 45 , 49 baseline data were acquired by a retrospective examination of case records, except for a few exceptions. 34 , 37 , 39 , 50 However, even with those exceptions, the prospective nature of the study design was highly limited in some, either because of the extreme shortness of the follow‐up period (24 h), 39 or an obscure distinction between baseline and follow‐up data. 33 The study of Mayor et al 37 was done with a strictly prospective design, though the responder rate remained at 40%.…”

“…Overall, the major clinical outcomes shown in the former type of follow‐up studies have been discouraging. In both short‐ and long‐term studies, the average rate of PNES cessation is generally reported to be low, ranging from 13% to 55%, 16 , 18 , 23 , 25 , 26 , 27 , 29 , 30 , 31 , 32 , 33 , 35 , 36 , 37 , 38 , 40 , 41 , 42 , 43 , 44 , 45 , 47 , 49 , 50 except for a few reports among those exclusively dedicated to children and adolescents, 18 , 19 , 46 , 48 with the rates in those ranging from 66–83%. The seizure cessation rate in the present study (48.9%) was close to the upper limit in previous studies.…”