Abstracts

Pediatric patients with psychogenic nonepileptic seizures (PNESs) often present at epilepsy centers for evaluation; however, research suggests the manifestation of PNESs in pediatric patients is different than that demonstrated by adults. The objective of the present investigation is to describe the clinical and psychosocial presentation of pediatric PNES patients admitted to an inpatient epilepsy unit.
Medical records of 22 pediatric patients with PNESs were reviewed retrospectively. Participants had been admitted to an inpatient epilepsy unit from September, 1999 to February, 2003 for continuous video-EEG monitoring to clarify episodes of undetermined etiology or because they were refractory to treatment with anticonvulsant medication. Patients were included if a typical event was recorded and the event did not have any EEG correlate. Patients with physiological nonepileptic events and those not formally evaluated by the primary author were excluded.
Of 22 participants, almost all were female (2M; 20F). 8 patients (36%) had a history of epileptic seizures. 6 patients without a history of epileptic seizures had been taking anticonvulsant medication prior to their admission. Mean age of symptom onset was 13 years (range=7 to 19 years). Mean duration of symptoms prior to admission was 7 months (range=[lt]1 month to 36 months); however, 62% of patients (n=13) were admitted within 2 months of their first event. Neuropsychological testing available for 13 participants indicated that 69% (n=9) had average to high average intellectual abilities, yet 50% of all participants were in special education. On average, patients presented with 5 different clinical symptoms (range=1 to 8). Symptoms most frequently reported included pain, shaking/jerking, dizziness, staring and unresponsiveness. Mean number of stressors experienced was 5.5 (range=2 to 9). A majority of participants identified school and/or peer issues as significant stressors (95% and 64% respectively). Traumatic sexual experiences were reported by 36% of patients. Stressors experienced by at least 25% of all participants included family conflict, parental psychopathology, not living with both biological/adoptive parents, health problems in one[apos]s immediate family, and grief. A majority of patients (68%) reported a tendency to manage stressors on their own rather than spontaneously seeking external social support; however, all patients reported receiving secondary gain for their symptoms. 19 participants (86%) met diagnostic criteria for a somatoform disorder and 11 patients (50%) had more than one psychiatric diagnosis (e.g., ADHD, anxiety, mood disorder).
The typical pediatric patient with PNESs is female and presents with symptoms during early adolescence. Several clinical symptoms resulting in secondary gain and consistent with a somatoform disorder are usually reported. In addition, patients often experience multiple stressors, but do not seek external social support to cope.