Abstracts

Pseudoseizures are a well described clinical entity in adolesent and adult populations. However, little is know about etiologies, co-morbity, and outcome of pseudoseizures in children less than 12 years old., Review of the Epilepsy/EEG database at Children[apos]s Medical Center at Dallas, revealed 12 children less than 12 years old with psychogenic non-epileptic paroxysmal events. Chart review and review of EEG and Video-EEG data was then done to assess age of onset, associated co-morbidities, EEG patterns, MRI findings, and psycho-social history. Follow-up data was available on 11/12 children., Of the twelve children identified, 6 were girls. Age of onset of non-epileptic events ranged from 3.5 years to 11 years old (median 8 years old). 7/12 had a previous history of epilepsy and were on antiepileptic medications. One child was on Depakote for 5 years despite all events since onset likely representing non-epileptic events. The most common semiology for this younger age group was staring ahead/unresponsive to verbal stimulation, all with a volitional component and apparent secondary gain. Less frequent patterns included myoclonic jerking (1/12), pelvic thrusting (1/12), generalized shaking (1/12) and focal right arm [quot]waving[quot] (1/12).
In three of the 12 children, interictal EEG abnormaliteis were present, including focal discharges and generalized spike and slow wave discharges. In one child, both epileptic and non-epileptic seizures were captured during a single 36 hour prolonged video-EEG monitoring period. Significant psychosocial stressor were identified in nearly all children, with 2/12 having had recent sexual abuse, 3/12 associated with parental separation/divorce, 1/12 recently placed under Child Protective Services custody for maternal Munchausen by proxy, and the remainder having various other stressors including school bullying., Although likely less common than pseudoseizures in older children and adolescents, non-epileptic seizures are not rare in the younger child, seen to occur in our series in children as young as 3.5 years old for secondary gain or with a volitional component. The most common semiology in the younger child appears to be more bland, with the majority demonstrating periods of staring/unresponsive to verbal stimulation. Psychologic/psycho-social stressors must be thoroughly evaluated in the child to assist in management and treatment of pseudoseizures in this age group.,