Abstracts

Rationale: Seizures or epilepsy may be part of Munchausen Syndrome by Proxy(MSBP) in children. MSBP is important to consider when it is suspected that children have been the victims of parentally induced or fabricated illness. Induced ilness is a severe type of abuse which may cause permanent injury or death. It can be difficult to diagnose when the symptoms are episodic as in epilepsy. Additionally, the parents are often skilled at appearing caring and nurturing. We reviewed our experience over the past year with children monitored in our Epilepsy Monitoring Program who were referred to Child Protective Services for MSBP. Methods: We reviewed all pediatric admissions to our University of Maryland Epilepsy Monitoring Program for 2010-2011. For all patents with suspected MSBP, we carefully explained the monitoring procedure and goals. Parents were informed that not only would EEG be recorded, but that a video camera was also recording. Records were reviewed daily and close nursing observation was also present to intervene if necessary. Daily discussions of events and parental interactions were held with the pediatric team.Results: Two patients with MSBP were identified. They were between the ages of 2 years and 3 years. Case #1 was a 2 year old male who had previously been monitored at 2 mos of age and at 1 year of age without evidence to confirm seizures. On this admission, during 4 days, typical episodes (subtle jerking during sleep) were captured without an EEG correlate. During his evaluation, Social Work became concerned that mother was embellishing diagnoses for her children. She reported that her other three children all had life threatening illnesses. A report to Child Protective Services was thus made. Case #2 was a 3 year old female who had been diagnosed with a seizure disorder by the emergency department when mother repeatedly brought her in for seizures. Despite increasing antiepileptic medications, the patient s seizures were reported to increase in frequency and severity. Additionally,the mother demanded a G-tube and tracheostomy for her child. The patient was monitored for 3 days during which time she had 8 mother triggered push button events without any EEG change. The decision was made to report to Child Protective Services because of the mother s aberrant perception(s) of her child s condition. Conclusions: Continuous video EEG monitoring was helpful in the assessment of seizure issues in children with MSBP. Although overt harmful behavior was not captured, the disparity between the severity of reported events and the actual minor events, if any, was valuable. Additionally, at times, observation of the interaction between patient and parent can also be informative. For example, until Case #1 was admitted and monitored, we were unaware of the similar pathology involving all the children in the family. Case #2 already had numerous red flags and the monitoring was able to provide additional objective findings to support the diagnosis of MSBP. Inpatient video-EEG monitoring in such cases can help clarify the diagnosis of MSBP and lead to actions to protect the children from future harm.