Abstracts

Rationale: Psychogenic nonepileptic seizures (PNES) has a prevalence rate of 3.5% to 20% in pediatric patients who undergo video EEG and is frequently misdiagnosed (Operto et al., 2019). Few studies have investigated the impact of adverse childhood events (ACEs) and attachment style on pediatric patients with PNES. The goals of this study are to 1) establish the relationship between ACEs and attachment style in patients with PNES in comparison with epilepsy; 2) to assess if the grey matter (GM) volume of the Anterior Cingulate Cortex (ACC) alters in patients with PNES in comparison to patients with epilepsy and whether ACC volume relates to ACEs or attachment style.

Methods: 25 patients, ranging from 8 to 21 years old, with video-EEG confirmed PNES diagnosis and 25 age matched patients with epilepsy diagnosis at Le Bonheur Children's Hospital, Neurology Clinic or EMU are included. The study is approved by Institutional Review Board, and all subjects and/or parents provide informed consent prior to enrollment. Four standardized questionnaires, Inventory Parent-Peer Attachment scale, Adverse Childhood Events Score, the Family Affluence Scale and Self-Perception Profile, are used to assess psychosocial risk factors of PNES. MRIs are obtained from patients’ chart. Data are analyzed by IBM SPSS. Chi-square analysis is used for categorical variables, whereas Mann-Whitney test is used for continuous variables. MRIs are analyzed by FSLVBM. Pearson’s Correlation is performed to assess the association between grey matter volume and ACE, attachment style, and self-perception.

Results: Data from our pilot study suggests that 45.9% of patients with PNES experienced ACEs prior to the onset of the disorder. Thus, we expect patients with PNES to display higher level of emotional dysregulation and dysfunctional attachment, demonstrated as increased level of communication and decreased level of trust to parents, lower level of self-perception and higher ACE score. We expect that grey matter of ACC is reduced in subjects with PNES and that grey matter of ACC is correlated to emotional dysregulation.

Conclusions: Understanding the impact of adverse childhood events and the implications of attachment style in patients with PNES can id clinicians in developing targeted treatment and may improve the efficiency of psychotherapy. Assessing the relationship between brain abnormalities and psychological/physical symptoms provides better understanding of PNES from biological, psychological, and socio-environmental standpoint.
ACC plays a significant role in the regulation of emotions and cognitive processes. The loss of GM volume in the ACC is observed in patients with PTSD and mood disorders (Yucel et al., 2003). Understanding the change of ACC volume in patients with PNES may help us further study the biological basis of comorbidity between PNES and other mental illnesses.

Operto, F. et al (2019). Psychogenic nonepileptic seizures in pediatric population: A review. Brain Behav., 9(12).
Yücel, M. et al (2003). Anterior cingulate dysfunction: implications for psychiatric disorders? JPN, 28(5), 350–354.

Funding: Please list any funding that was received in support of this abstract.: This project is funded by University of Tennessee Health Science Center College of Nursing Dean’s Research Fellowship Award.