Abstracts

This study examined the rate, types, and demographic features of non-epileptic events (NEE) in a large pediatric epilepsy center over 5 years. The single pediatric study conducted to date found NEE in 15.2% of the children (Kotagal 2002). These included stereotyped and paroxysmal movements, hypnic jerks, parasomnias, Sandifer syndrome, inattention and conversion disorder. Epilepsy was found in 19-25% of the middle childhood and adolescent cases., A chart review was conducted on all children under 18 years with NEE during long term videotelemetry at UCLA between 2000 and 2005. Patients with auras were excluded from this study since it is unclear whether these spells were NEE or not. Information gathered included ethnicity, gender, age at time of telemetry admission, history of psychiatric illness, type of medications, history of epilepsy, history of developmental delay, EEG ictal data (if the patient had a seizure), and type of NEE. Type of NEE was categorized as arousal/sleep myoclonus, abdominal complaints (reflux), apnea, psychiatric disorders (psychosis, impulse control disorder, conversion disorder), movement disorders (tics, dystonia, tremors, myoclonus) and staring., 469 of the 1509 telemetry admissions had NEE. Among these 469 patients, 150 had movement disorders, 112 sleep related issues, 107 staring, 16 gastrointestinal related issues, 16 apnea (mainly breath holding spells), and 8 headaches. Many had different types of NEE noted in the same procedure. 128 patients had a psychiatric diagnosis with a conversion disorder in 31 and impulse control disorders psychosis, masturbation or enuresis in the remaining 97 children. Of those with conversion disorders, 13 were female and 18 male ranging in age from 3-18 years (mean 12.87 yrs). The ethnic distribution was similar to that of the greater Los Angeles community. 14 children had a past history of epilepsy and 3 had documented epileptic seizures during the same telemetry. Six patients had no medication treatment for epilepsy or psychiatric condition prior to the telemetry, 3 had treatment for a psychiatric condition and 25 had treatment for seizures. 12 patients had a prior psychiatric history of depression (2), bipolar disorder (1), psychosis (5), attention deficit disorder (2), and autism (2). 9 patients had a history of mild mental retardation or learning disability., Unlike Kotagal et al. (2002), 31% of our telemetry patients had NEE. 27% had comorbid psychiatric disorders with conversion disorder in 7% of all telemetry cases. There also was a higher rate of previous epilepsy (45%) and past psychiatric history (39%) in the NEE cases associated with conversion disorder. The high rate and marked morbidity of this disorder highlights the importance of further studies to identify neurocognitive and socioeconomic factors that increase the risk of children with epilepsy for this disease.,