Abstracts

There is a 10-15% rate of nonepileptic seizures (NES) in adults admitted to the epilepsy monitoring unit. It is well documented that patients with NES may also have epileptiform discharges or ictal events. Nonepileptic events have been poorly characterized in children. We reviewed the neuropsychological findings in children with NES., Admissions for prolonged video-EEG monitoring were retrospectively reviewed from November 2005 to April 2006 in an ongoing study of children with NES. These patients had detailed neuropsychological testing and brain MRI with epilepsy protocol., Seventy-two children were admitted for prolonged video-EEG in this 6 month period. Nine patients (12.5%) were found to have objectively documented NES. Their ages ranged from 5 to 18 years. Eight of the patients had a normal MRI. The ninth patient had bilateral parietal damage (left greater than right) due to a motor vehicle accident. During the video-EEG monitoring, 2 of the 9 patients had both epileptic and NES. No seizures were captured in the other seven individuals. Of the 9 patients in the study, all but 2 had frequent interictal epileptiform discharges. Five out of the 9 patients had right hemispheric discharges (3 right temporal, 1 right parietal, 1 both left and right temporal). Two patients had generalized discharges. Age-appropriate detailed neuropsychological testing revealed no significant Verbal IQ/Performance IQ split in 8 of the 9 patients. One patient had an IQ [lt] 70. All but one of the patients had impairments in executive functioning that suggested posterior frontal lobe impairment; 2 of these patients had bilateral impairment, 5 were impaired on the right and 1 was impaired on the left. Fine motor dexterity was impaired in 6 of the 9 individuals. The left hand was impaired relative to the right in 4 of these patients; 2 patients had bilateral impairment. More diffuse changes were seen in visual perception, memory, and language in individual patients. All but 3 of the patients had mental health diagnoses, according to results from the Child Behavior Checklist and/or MMPI. One patient had conversion disorder, 2 patients had somatic diagnoses, and 3 patients had depression., In this ongoing study, we have documented a small but significant group of children with nonepileptic seizures, some also with epileptic events. The majority had right hemispheric epileptiform discharges. All but one of the patients with these discharges had right executive function abnormalities, and the majority had fine motor dexterity impairments consistent with right hemisphere dysfunction. Children with nonepileptic events are more likely to have right-sided epileptiform discharges and right hemisphere neuropsychological dysfunction, primarily affecting executive function.,