Abstracts

Rationale: Children with non-epileptic events (NEE) often have behavioral profiles that are difficult to characterize. Complexity stems from the variability of anxiety and somatic symptoms potentially associated with epilepsy or conversion disorder—both heterogeneous conditions themselves. There is no consensus in the literature regarding ideal assessment tools that differentiate NEE from epilepsy. We completed a pilot study using a broad range of behavioral assessments in order to identify domains that differentiate the two populations and determine predictive variables for NEE. Methods: Pediatric patients and their parents were recruited from video EEG monitoring services in a multi-site, cross-sectional study. All subjects had documented evidence of either NEE or electrical seizures. Subjects and their parents completed a battery of commonly used questionnaires to assess mood and anxiety symptoms, expression of emotions, somatic preoccupation and perception of health status. Measures included the Child Behavior Checklist (CBCL) completed by parents, and the Multidimensional Anxiety Scale (MASC), Childhood Depression Inventory (CDI), Childhood Anxiety Sensitivity Index (CASI), Childhood Symptom Inventory (CSI), Toronto Alexithymia Scale (TAS) for Children-Revised, and Functional Disability Inventory (FDI) completed by the child. Group comparisons were made between subjects diagnosed with NEE versus those diagnosed with epilepsy for summary scores as well as individual items on questionnaires. Results: 48 participants were recruited from five pediatric centers in the United States. 24 had epilepsy (mean age 13.6, SD 3.0; 13 female, 11 male), and 24 had NEE (mean age 14.0, SD 3.0; 14 female, 10 male). The CDI, MASC, and TAS did not yield significant differences between NEE and epilepsy. The CBCL yielded higher internalizing problems (p=0.03) and somatic complaints (p=0.01) in NEE versus epilepsy. Group differences were observed in summary scores for the CSI (p=0.01) and the FDI (p=0.03). Specific items yielded robust differences on these measures as well as on the CASI. Sample items that were significantly higher for NEE included: “It scares me when I have trouble getting my breath” (p=0.05), “…physical difficulty…doing the activities in gym class” (p=0.005), and “Other kids can tell when I feel shaky” (p=0.003). Conclusions: Measures of somatic preoccupation and functional disability (parent CBCL and child self-report on the CSI, CASI and FDI) differentiated children with NEE from those with epilepsy. Measures of anxiety (MASC), depression (CDI), and expression of emotions (TAS) did not differentiate the two groups. Questionnaire items significant for NEE may reflect an elevated level of anxiety specifically directed towards somatic symptoms. Future studies that investigate the predictive power of somatic preoccupation in NEE patients may provide sensitive outcome measures for treatment trials.