Pseudoseizures in Children: A Profile of 50 Cases

Abstract

In contrast to adulthood hysterical disorders, childhood hysteria has not been accorded due recognition. Pseudoseizures are paroxysmal alterations in behavior that resemble epileptic seizures but are without any underlying organic cause. There is paucity of literature on pseudoseizures in children. In the present descriptive study of 2 years' duration, a series of consecutively seen 50 children with pseudoseizures is reported. After detailed history from parents, various socio-demographic and clinical variables were noted. Of 110 children seen with conversion disorder, 50 had pseudoseizures (45.5%). The average age was 8.2 years in boys and 9.4 years in girls. There were 28 girls (56.0%) and 22 boys (44.0%), and the majority of patients had the pseudoseizures for 1 to 3 months. When the mode of referral was studied, 52% were referred from pediatric outpatient department and the majority were referred to rule out comorbid psychiatric disorder. The fits mimicking generalized tonic-clonic seizures were most common and the duration of fits ranged from 10 to 35 minutes. The most common frequency of fits was 5 to 6 per week. The average duration of symptoms was 2.6 months in boys and 3.2 months in girls. Only 14 patients (28%) gave the history of having seen the fits in a relative or schoolmate. School phobia and the fear of examinations were the most common precipitating factors. Separation anxiety disorder, school phobia, and mood disorders were common comorbid diagnoses. The patients were put on appropriate drug treatment and/or psychotherapy for 3 months. Of 50 cases, 36 (72.0%) remitted, 10 (20.0%) showed a decrease in frequency of pseudoseizures, and 4 (8.0%) did not improve. With correct diagnosis and treatment, the children with pseudoseizures have a good outcome.

Pseudoseizures: A Case Report.

“…He was suffering from repeated attack of involuntary movements affecting all his four limbs, but during the vent he was aware of his surroundings and he regained full consciousness and function after the event. Pupillary dilatation is not common, however it was observed a mild papillary dilatation [11], in the present case there was no papillary dilatation. Bladder incontinence is rare in Pseudoseizures [11], our patient did not loss bladder control.…”

“…Bladder incontinence is rare in Pseudoseizures [11], our patient did not loss bladder control. The time for seizure episodes ranged from 4 seconds to 19minuts [11], in the present study the patients , neck hyperextension around 30 seconds every time.…”

“…Diagnosis of Pseudoseizures must be precisely recognized because mistake in diagnosis can be harmful [9]. Actually it is very difficult to diagnose Pseudoseizures due to presence of overlapping in syndromes of real epilepsy with pseudoepilepsy [11]. There are many charachteristics of Pseudoseizures including no tongue bite, absence of urinary incontinence, normal pupillary reflex and normal pupil size where, it is dilated in organic seizures, occurrence of event in all times, especially when the patient is awake among all the relatives, or persons related to the issue, and plantar reflex is always flexor [1,11].…”

“…Actually it is very difficult to diagnose Pseudoseizures due to presence of overlapping in syndromes of real epilepsy with pseudoepilepsy [11]. There are many charachteristics of Pseudoseizures including no tongue bite, absence of urinary incontinence, normal pupillary reflex and normal pupil size where, it is dilated in organic seizures, occurrence of event in all times, especially when the patient is awake among all the relatives, or persons related to the issue, and plantar reflex is always flexor [1,11]. In the present case almost all the previous conditions where exist with our patient, the patient did not suffer tongue biting and had no loss in bladder control, also there was no pupillary dilatation, the patient usually develops the events during physician rounds or visiting hours it was recorded that plantars were downing.…”

Executive Summary: Evaluation and Management of Children With Acute Mental Health or Behavioral Problems. Part II: Recognition of Clinically Challenging Mental Health Related Conditions Presenting With Medical or Uncertain Symptoms

“…18 Because of diagnostic uncertainty, patients with somatic symptom and related disorders are at risk for extensive, invasive, or potentially harmful testing and interventions in the ED. 19,20 • ED management strategies 8 …”