Abstracts

Rationale: Paroxysmal non-epileptic events (PNEs) are observable, abrupt changes in consciousness or behavior that present similar to seizures but are not accompanied by electrophysiologic changes. Frequency of PNEs in the pediatric literature ranges between 10-23% of individuals referred to an epilepsy clinic. Cases are likely underreported due to the difficulty in accurately defining PNEs symptoms, leading to inappropriate use of AED's and diagnostic procedures. Very little information is available regarding the clinical characteristics, treatment and outcome of PNEs in children and adolescents. Accordingly, we strove to better understand the etiology, features and medical care pathway of PNEs in a pediatric population of patients seen at the Alberta Children’s Hospital. Methods: Our group embarked on a retrospective chart review of children referred to a neurology clinic, then clinical psychology with a final diagnosis of PNEs.  Charts were examined for demographics, non-epileptic presenting symptoms, psychological testing results, neurological testing, co-morbidities, management and outcomes.  All patient underwent similar assessment involving parental ratings and self-report measures including the; Behavior Assessment System for Children-Version II and Beck’s Youth Inventory.  Patients 13 years of age or older were administered the Millon Adolescent Personality Inventory, a self-report personality assessment.  In addition to medical diagnosis and education, all patients received psychological assessment, diagnosis and PNEs education.Treatment was consistent with that described in the adult and pediatric literature and occurred over brief periods to several months in a non-linear and multimodal fashion.  Results: The majority of patients identified were adolescents, Caucasian (72.4%) and female (75.9%).  Initial entry into medical care was via emergency room department (65.5%) and outpatient neurology clinic (31.0%).  Participants’ levels of suggested distress on a personality inventory were highly discrepant from those indicated on parent and face valid self report measures.  The most prevalent personality findings were significantly inhibited and submissive personality types as well as highly shared traits with youth suffering clinical levels of anxiety and depression.  It was also displayed that a high number of medical contacts as compared to psychologist contacts correlated with refractory PNEs, where predominantly psychological care led to remission status.  Lastly, appropriate psychological treatment facilitated a high rate of remission (54.2%) and partial remission (25.0%) leading to a significant decrease in emergency department visits (84.4%). Conclusions: Accurate identification, diagnosis and treatment is essential in order to provide appropriate care for children and adolescents with PNEs.  This study has furthered knowledge around common traits and treatment avenues effective for this population.  This study supports that appropriate care expedites rates of remission, decreases health care costs and mediates inappropriate use of AEDs.