Psychogenic Nonepileptic Seizures in Children and Adolescents

Abstract

Though psychogenic non-epileptic seizures (PNES) are seen commonly during evaluation of children and adolescents with epilepsy, the literature regarding developmental changes in PNES is limited. Evidence Acquisition: Literature search was conducted in PubMed. Key search terms included: Pseudoseizure* OR PNES OR [(non-epileptic or nonepileptic or psychogenic or non-epileptic attack disorder) AND (seizure*)], resulting in 3,236 articles. Filters included human, ages 1-18 years, English language and last 15 years (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019), resulting in 533 articles. We reviewed 33 articles, which included 19 articles that involved children (1-18 years), with 10 or more children with PNES in their study group. 21 articles obtained in cross references that were outside the filter setting (including time frame and age range) were also reviewed, for a total of 54 articles. Results: Majority of the studies were retrospective. We detail clinical features, predisposing factors and appropriate workup for children and adolescents with possible PNES. There is no consensus regarding frequency of psychiatric comorbidities in children with PNES. No controlled trials of treatment of PNES in children are available, but cognitive behavioral therapy is the consensus for adult PNES. Outcome appears to be better in children with PNES. Conclusions: There is a need for be long-term prospective studies to document various clinical features and outcome of pediatric and adolescent PNES, and also the comorbid conditions.

Childhood Epilepsies and When to Refer for Epilepsy Surgery Evaluation

“…Complicating the diagnosis of epilepsy are the many seizure mimics which include inattentiveness as is seen with attention deficit hyperactivity disorder (ADHD), sleep disturbances, autism spectrum disorder with poor social reciprocity, stereotypies, self-gratification behaviors, other subcortical movement disorders such as tic disorders, and psychogenic nonepileptic spells [15][16][17]. For this reason, if there is a low clinical suspicion of epileptic seizure, video EEG (VEEG) to spell capture events can be very helpful to rule out seizures, while routine EEG and head imaging are helpful for ruling in a diagnosis of epilepsy.…”

“…Activities generally considered safe for children with epilepsy are sports without heavy contact, standing water, or heights. Photosensitive epilepsy can be ruled out by exposing the patient to various flash frequencies (1,3,6,9,12,15,20,and 30 Hz) while hooked to EEG. Children with epilepsy should be given autonomy to select safe activities with their peers to improve their quality of life [68][69][70].…”

The neurobiology of functional neurological disorders characterised by impaired awareness

“…Interestingly, it has been defined as the process that enhances representation of some kinds of information and inhibits others (248), thus privileging the former over the latter for further processing. It has long been hypothesised that « dissociative » disorders, and FIAD, in particular, involve biased attention, we researched the sources that cited original search articles to find (249)(250)(251)(252)(253)(254)(255). For example, experimental participants scoring high for dissociation on a selfreport scale showed reduced attention to somatosensory stimulation after they watched a trauma-related film (162,(256)(257)(258)(259)(260).…”