Abstracts

Rationale: PNEE are intermittent, brief, sudden spell in children that resembles seizure activity but are not associated with abnormal electroencephalogram (EEG) activity in the brain. They can result from a variety of different medical, psychological or behavioral reasons. Recognition and diagnosis is established by detailed history, physical examination and observer description bur often require Video electroencephalogram (VEEG) conformation to make an accurate diagnosis. In this retrospective study we aim to analyze the epidemiological similarities and differences in the five subcategories of paroxysmal non epileptic events in children. Methods: 248 patients were admitted to the Pediatric Epilepsy Monitoring Unit (PMU) at Batson Children’s Hospital, University of Mississippi Medical Center with suspicion of paroxysmal non-epileptic events from July 2013 to January 2017. Retrospective study of chart review of all patients including video electroencephalogram (VEEG) was done. We only captured non-epileptic events on VEEG in 109 pediatric patients during their admission. A total of 3 of the patients had 2 types of events during one stay. Results: We categorized PNEE based on VEEG report into five categories: 1. psychogenic non-epileptic spells, 2. benign paroxysmal events during sleep, 3. benign events of movement, 4 paroxysmal behavioral events and 5. Other episodic events. The female to male ratio was 1.13:1. Age of onset ranged from 2 weeks of life to 16 years with a mean of 5.3 years. PEMU length of stay to capture an event ranged from 1 to 5 days with a median stay of 3 days (44%).Paroxysmal behavioral events: 42(37.5%) patients with age of onset between 1 week to 11 years had behavioral events (14 behavioral staring, 10 stereotypies, 14 attention seeking behaviors, 2 breath holding spells and 2 self-gratification behaviors).  19 patients were male and 23 were female. Paroxysmal events during sleep :31(27.6%) patients with age of onset between 2 weeks to 14 years had sleep events (10 benign sleep myoclonus, 19 sleep arousals, 1 apnea during sleep and 1 rapid eye movement (REM) sleep). 17 patients were males and 14 were females.  Benign events of movement: 4(3.5%) patients with age of onset 3 to 10 years had benign movement events (1 paroxysmal dystonia, 2 tics/Tourette’s syndrome and 1 restless leg syndrome). 2 of those patients were female.  Psychogenic non-epileptic spells.  18 (16%)patients with age of onset from 9-16 years were diagnosed with psychogenic non-epileptic spells. Of those patients, 14 were females.  6 of those patients had history of childhood or juvenile epilepsy as a co-morbidity.Other episodic events :13 (11.6%)patients had other episodic events aged 7 months (reflux), and between 5-10 years old (8 headaches, 3 autonomic dysfunction spells, 1 reflux and 1 respiratory distress).Out of the 109 patients who has PNEE 23 (21%) patients has concurrent epilepsy, 5 had neonatal or childhood epilepsy that resolved and 2 patients had febrile seizures in childhood. Conclusions: Given the commonality of the childhood epilepsy, a high index of suspicion is warranted when it comes to evaluating episodic events in the pediatric population. Paroxysmal non-epileptic events are quite prevalent in this age group and can be mistaken for epilepsy, with a variety of semiological presentations, with different events featured in childhood than adolescents.  Within this wide range of described events, VEEG plays a huge role in differentiating between epileptic and non-epileptic events.  In addition, close to 1/5 of children found to have these paroxysmal events has a current or former history of seizures.  Early recognition and diagnosis of non-epileptic events would minimize the use of antiepileptic drugs use as well as medical costs for recurrent admissions. Funding: none