FREQUENCY OF SECONDARY CONVERSION SYMPTOMS IN CHILDREN AND ADOLESCENTS WITH PSYCHOGENIC NON-EPILEPTIC SEIZURES
Abstract number :
1.396
Submission category :
Year :
2003
Submission ID :
3936
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Juliann Paolicchi, Ann Pakalnis Department of Pediatrics, Children[apos]s Hospital, Columbus, OH; Department of Neurology, Ohio State University, Columbus, OH
Children and adolescents with psychogenic non-epileptic seizures (NES) may be more likely to develop other conversion symptomatology. NES are found in about 10% of pediatric epileptic patients (Holmes et al, 1980). Development of conversion symptoms other than NES can be co-existent in this susceptible population and has been documented in adults with NES (Ettinger et al, 1999). Evaluation of NES patients with other conversion symptomatology regarding type, frequency, and risk factors will facilitate easier recognition, treatment, and avoidance of iatrogenic complications.
We identified children and adolescents under 18 years old studied with video EEG telemetry and diagnosed with NES. 17 patients (14 were girls, average age = 13.7 years) were identified over an 18 month retrospective of 189 patients. 3 children had co-existent epilepsy (2 had temporal lobe epilepsy and 1 had juvenile myoclonic epilepsy). History of conversion symptomatology was identified such as headaches chronic pain, or other persistent somatic complaints without organic etiology. Risk factors such as head injury, sexual/physical abuse, psychiatric diagnosis and past history of epilepsy were elicited from records or follow-up interviews to determine an association with secondary conversion symptoms in our pediatric population.
8 patients (7 girls) developed other conversion symptoms. 4 had headaches, 1 abdominal pain, 2 gait abnormality, and 1 both headache and gait disturbance. None of the epileptic patients had other conversion symptoms. 6/8 patients with secondary conversion symptoms had history of sexual/physical abuse; none of the patients with epilepsy had this history. 2/8 patients had history of head injury. Depression was the most common psychiatrics diagnosis (6/8 patients).
47% of our NES patients had secondary conversion symptoms, which were frequently neurologic manifestations. Individuals who had concurrent NES and other conversion symptoms had a high association with depression and history of abuse. These features identify a population who require intensive psychological therapy and may be at risk for long-term pathology.