Abstracts

Rationale: Physical and emotional abuse are well-documented risk factors for Conversion disorders (CD), including psychogenic Non-Epileptic Seizures (pNES). Child-to-parent violence (CPV) is a less-recognized, often hidden form of trauma, defined as intentional acts caused by a child to inflict physical, psychological, or financial pain upon a parent.1 Distinct from other forms of domestic violence, CPV has been linked to proactive (i.e. planned, vs. reactive) aggression.2 Victims are typically mothers, which may partially explain underreporting of violent acts in the home. To our knowledge, there are no published cases CPV-related CD or pNES. We present two cases of CPV-associated pNES, and highlight unique diagnostic and treatment challenges of CPV in patients with imitators of medically intractable epilepsy. Methods: Clinical and neuropsychological findings of two female patients with vEEG-confirmed pNES and previously undisclosed histories of CPV-associated onset are presented. Unique descriptive findings, including demographic, video-EEG, and neuropsychological data are reported. Results: The first patient had a history of epileptic seizures (ES) s/p neurovascular insult. Both ES and pNES events were documented during inpatient EMU admission, the latter increasing in frequency and severity at a time of CPV escalation. In contrast, all of the second patient s typical events were without electrographic correlate, but similarly worsened with increased frequency of CPV incidents. Both patients presented with stereotyped events of diminished awareness/consciousness, complaints of memory decline, and histories of depression, remote and family-of-origin ETOH. Neuropsychological profiles were nonspecific, although the ES/pNES patient had evidence of focal insult consistent with neurosurgical history. MMPI findings were highly discrepant, and neither conformed to a classic Conversion V. Notably, the pNES-only patient produced a normal profile, with MMPI responses discrepant from clinical presentation and interview findings. The patient with ES/pNES produced a pattern associated with significant depression, anxiety, and somatic reactivity to stress. Conclusions: CPV is a marginally understood, but increasingly recognized form of domestic violence that may markedly affect the health and well-being of female patients with known and suspected CD. Awareness of CPV as a risk factor for pNES, as well as other forms of CD, may result in improved diagnostic accuracy and treatment efficacy. Future research is needed to understand the scope and semiology of this rising public health concern.