Paroxysmal Nonepileptic Events in Children and Adolescents

Abstract

ABSTRACT. Objective. Paroxysmal nonepileptic events (PNEs) are frequently encountered in children and adolescents; however, there is little information concerning the relative frequency of various types of these disorders. We report our experience with PNEs in a group of children and adolescents who underwent prolonged video-electroencephalographic monitoring.Methods. During a 6-year period, 883 patients were monitored in the Pediatric Epilepsy Monitoring Unit and 134 patients (15.2%) were documented to have PNEs on the basis of a typical spell recorded during monitoring. Their hospital charts were reviewed and videotapes of these events were analyzed.Results. Patients were divided into 3 age groups: 1) the Infant, Toddler, and Preschool Group (2 months-5 years) that comprised 26 patients. The most common diagnoses were stereotyped movements, hypnic jerks, parasomnias, and Sandifer syndrome. Concomitant epilepsy was present in 12 patients (46%). 2) The School-Age Group (5-12 years) consisted of 61 patients. The most frequent diagnoses were conversion disorder (psychogenic seizures), inattention or daydreaming, stereotyped movements, hypnic jerks, and paroxysmal movement disorders. Fifteen patients (25%) had concomitant epilepsy. 3) The Adolescent Group (12-18 years) consisted of 48 patients, of whom 40 patients (83%) were diagnosed with conversion disorder. Nine patients (19%) had concomitant epilepsy.Conclusions. In our patients with PNEs, conversion disorder was seen in children >5 years old and its frequency increased with age, becoming the most common type of PNEs among adolescents. In adolescents, conversion disorder was more common in females, whereas males predominated in the school-aged group. Concomitant epilepsy with nonepileptic events occurred in all 3 age groups to a varying extent. Pediatrics 2002;110(4). URL: http://www.pediatrics.org/cgi/content/full/110/4/ e46; nonepileptic, paroxysmal, psychogenic seizures, children, adolescents.

Nonepileptic seizures treatment workshop summary

“…children and adolescents. For example, the gender distribution of NES appears to change during development, being similar in young boys and girls, but higher in female teens than male teens [1]. These findings are based on a small sample size and need to be replicated.…”

“…From the developmental perspective, there are differences in the incidence, etiology, clinical presentation, treatment, and outcome of NES in younger compared with older patients [1]. Thus, children who experience nonepileptic events have a wide range of seizurelike manifestations [1][2][3][4] that vary by age [1].…”

“…Thus, children who experience nonepileptic events have a wide range of seizurelike manifestations [1][2][3][4] that vary by age [1]. In children younger than 5, these include physiological nonepileptic events, including stereotyped movements, hypnic jerks, parasomnias, and Sandifer syndrome [1][2][3][4], as opposed to psychological NES, which are noted to occur after age 6. In children aged 5-12, NES might be an expression of a psychogenic conversion disorder, inattention or daydreaming, stereotyped movements, hypnic jerks, and paroxysmal movement disorders.…”

“…In children aged 5-12, NES might be an expression of a psychogenic conversion disorder, inattention or daydreaming, stereotyped movements, hypnic jerks, and paroxysmal movement disorders. However, in adolescents, conversion disorder is the main diagnosis underlying NES [1]. In addition, comorbid epilepsy is more commonly reported in younger children with NES than in older children or adults with NES.…”

“…In addition, comorbid epilepsy is more commonly reported in younger children with NES than in older children or adults with NES. Forty-eight percent of children with NES under the age of 5 have comorbid epilepsy, whereas only 25% of those aged 5-12 years and 19% of adolescents do so [1]. It was noted that in children of all ages, the manifestations of syncope also can be confused with both epilepsy and NES [5].…”