Abstracts

Non-epileptic events are characterized by seizure-like behaviors without any associated EEG changes. Psychogenic seizures make the majority of the non-epileptic events in adults; however, the spectrum is much wider and includes both psychogenic and organic etiologies in pediatric population. Although, there is numerous literature on non-epileptic events in adults, limited data is available in pediatric population. We reviewed the data on the pediatric patients (age [lt]18 years) who underwent at least 24-hours long-term video-EEG monitoring (LTM) at the University of Michigan Hospitals. Patients with possible simple partial seizures without any EEG correlation and with uninterpretable EEGs were excluded. All EEGs and video events were first reviewed by an EEG fellow then by an attending physician board certified in clinical neurophysiology. Predominantly motor-behavioral events without any EEG correlation were classified as stereotyped movements in children [lt] 1 year old and as behavioral events in children older than 1 year with some degree of mental retardation. A total of 156 children were admitted for LTM during 12 month period. Out of these, 39 (25%) patients had non-epileptic events. Twenty patients were male (56%) and the mean age was 8.4 years (range 2 months-17 years). Four patients (10%) also had concomitant epilepsy. Psychogenic seizures were most common and occurred in 13 (33%) patients. Majority of patients (10 patients, 77%) with psychogenic seizures were adolescents (age [gt]12). Behavioral events were the second most common type of non-epileptic event seen in 9 patients (23%). All patients with behavioral events had mild-to-moderate degree mental retardation. Other diagnostic categories include parasomnias (10%), stereotyped movements (8%), daydreaming (5%), non-epileptic myoclonus (5%), and hand tremor, breath holding spells, presyncope, paroxysmal non-kinesigenic choreoatetosis, nocturnal enuresis, gastroesofageal reflux disease were seen in one patient each (3%). Non-epileptic events occurred in about one-quarter of our pediatric patients. Psychogenic seizures were the most common diagnosis in this population and occurred mostly in adolescents warranting psychologic counseling in this age group. Therefore, LTM is important in the pediatric population with paroxysmal events in order to prevent misdiagnosis because of various etiologies of the events.