Abstracts

Rationale: The main differential diagnosis for children with PNES is refractory epilepsy. Patients with PNES have more psychiatric disorders including depression, anxiety, other somatic disorders and disruptive behavior. However, the child neurologist usually overlooks these data that are usually obtained after the diagnosis of PNES. In this work, we aimed to evaluate whether there are main differences between these two groups taking into account the first neurological interview for epilepsy. Methods: We reviewed the data obtained with the first interview of 83 children and adolescents without mental retardation consecutively referred for diagnosis and treatment of epilepsy. Thirty-three children had PNES with a mean age of 12.94 years (SD 3.10 years) and 30 children had epilepsy with a mean age of 11.8 years (SD 2.27 years) were included. All children referred and included had focal epilepsy - symptomatic and undetermined. Twenty children with PNES and epilepsy were excluded from this analysis. Results: There was an earlier age of onset in patients with focal epilepsy (4.4 years [3.41]) compared to PNES (11.18 years [SD 3.79]) (p 0.000). In addition, patients with focal epilepsy had a longer duration of the disease (7.27 years [SD 3.08]) compared to PNES (1.53 years [SD 1.11]) (p 0.000). In patients with PNES, there was a higher frequency of events with motor phenomenon (p 0.018) and a lower frequency of events with aura (p 0.005). Dyscognitive seizures were equally represented. Periods of remission with AEDs occurred more often in patients with epilepsy (p 0.000). Family history of epilepsy was more frequent in children with epilepsy (p 0.016). The number of AEDs differs among groups and there was a higher number of patients with epilepsy receiving monotherapy. (p 0.001) Personal antecedents of note were more frequent in children with epilepsy (p 0.004). No difference was observed considering gender predominance. Presence of status epilepticus was equally represented in both groups. Febrile seizures only occurred in children with epilepsy. Conclusions: There were several clinical differences between patients with PNES and this group of children with focal epilepsy at the moment of the first interview. Patients with PNES showed predominant onset during puberty. PNES had a more catastrophic presentation with no remission and need of several AEDs leading to earlier referral compared to children with epilepsy. It is of note that these findings are highly unspecific when evaluated on individual basis. However, they are part of the routine investigation in child neurology and they may anticipate a psychiatric evaluation or guide to more specific question such as the presence of stressors and psychiatric disorders.