Abstracts

Rationale: The early and accurate recognition of Psychogenic Nonepileptic Seizures (PNES), and their differentiation of epileptic seizures (ES), is of paramount importance. There has been extensive work in order to determine which factors may postpone the diagnosis and consequent referral to video-EEG monitoring in adults. Data in childhood is still scarce, as demonstrate by Reilly et al. (2013) In this study, we evaluated which factors may play a contributory role for a longer delay in video-EEG referral and consequently, for the diagnosis in children and adolescents. Methods: We evaluated 53 children and adolescents (60.4% female; mean age of 12.85 years) with PNES who were diagnosed during video EEG monitoring. Medical records were also reviewed. A detailed analysis of the demographic, clinical and psychosocial characteristics was obtained. In the first statistical analysis, ANOVA was used for categorical variables and Pearson correlation for numeric variables. Clinical variables with a level of significance of p < 0.1 were evaluated with linear regression, using stepwise backwards and LASSO. Results: On average, children and adolescents with PNES were diagnosed 17.75 months (SD 12.62 months) after the initial manifestation. Younger age of onset was correlated with delay for diagnosis (p < 0.001). There was an association between the use of antiepileptic drugs and presence of neurological illness with a longer delay without statistical significance. Other factors such as gender, NES type, presence of epilepsy, epilepsy syndrome, epilepsy severity, NES status, family history of epilepsy, presence and type of psychiatric disorders, the type of environmental stressor and presence of other somatic complaints had no correlation with longer time for video-EEG referral. Conclusions: During childhood, younger age is associated with longer delays. Other patients' and physicians' factors did not explain this great variability. This finding highlights the difficulties to identify PNES in early ages and suggests that, in general, physicians rule-out this diagnosis in younger children. Reilly C, Menlove L, Fenton V, Das KB. Psychogenic nonepileptic seizures in children: a review. Epilepsia. 2013 Oct;54(10):1715-24.