Abstracts

Rationale: More definitive characterization of PNES is an area of increasing interest in the field, particularly among children.  Besides therapy, treatment efforts typically focus on addressing weaknesses in cognitive functioning, particularly in the areas of attention and memory.  Previous research among children with epilepsy has demonstrated difficulties with attention to be common.  Previous research among children with PNES, while limited, has demonstrated variable results regarding comparisons to those with epilepsy.  This study compares cognitive functioning among children with PNES to those with epilepsy, focusing on objective and subjective measures of attention.  Potential impact to treatment is addressed. Methods: A total of 37 cases of children, 22 with epilepsy and 15 with PNES were included in the study, based on results of VEEG monitoring and neuropsychological assessment (for the latter).  Children were administered a battery of tests which included the WISC-IV and NEPSY-II.  Parents completed the Conners 3 Parent and Achenbach CBCL questionnaires.   Means, standard deviations, ranges and t-scores were computed using SPSS. Results: Comparisons of objective measures of attention from the WISC-IV and NEPSY-II yielded no significant differences between the two groups.  Likewise, comparisons of subjective measures of attention difficulties yielded no significant differences between the two groups.  However, mean scores were consistently at clinical levels for the two groups.  On the other hand, comparisons of subjective measures of mood and anxiety symptoms yielded significant differences between the two groups, with children with PNES demonstrating higher levels of observed mood symptoms.   Conclusions: These findings demonstrated no significant differences on objective measures of attention between children with epilepsy and those with PNES.  Findings were consistent with a prior study demonstrating normal IQ and a lack of impairment for attention, executive, and memory functions among children with PNES.  However, findings were generally inconsistent with prior studies demonstrating problems with attention among children with epilepsy, although it should be noted that there was some variability within the group.  Findings of significant attention problems by parental report for both groups were consistent with prior findings.  On the other hand, findings of significant differences between the two groups regarding levels of mood symptoms were inconsistent with some prior research. These findings suggested that while both groups may experience cognitive difficulties in daily life, they may do so for different reasons.  For those with epilepsy, treatment addressing attention difficulties should focus on accommodations at school and consistent implementation of strategies at home.  For those with PNES, psychotherapy that would aim at developing coping skills and targeting mood issues might be recommendable as a primary focus, with secondary efforts also focused on development of accommodations and strategies, where appropriate.  Funding: No outside funding was recieved for this study