Abstracts

Rationale: Youth with psychogenic non-epileptic seizures (PNES) are an understudied group associated with significant medical and psychiatric morbidity, high cost due to utilization of frequent health-care services, and poor prognosis for future functioning without appropriate treatment (Plioplys, 2014). Few studies have examined diagnosis and treatment in youth; specifically their symptom remission, functional improvement and the treatment of the associated risk factors that contribute to PNES development. The current study examines these factors in a group of youth with PNES diagnosed and treated at the Minnesota Epilepsy Group. Methods: Pediatric patients aged 5-18 with a confirmed typical PNES episode on video EEG and who underwent a psychological evaluation were included. All 62 patients (48 female) were also enrolled in psychotherapy immediately after diagnosis at the Minnesota Epilepsy Group. Patient’s progress was evaluated from their diagnostic evaluation until treatment ended (56) or they were lost to follow-up (6). Data was extracted from semi-structured psychiatric interviews and therapy notes. Results: Mean age of PNES symptom onset was 13.9 years. Most patients (73%) were diagnosed within 6 months of onset of symptoms, with the range being 1 day to over 3 years. Those with a delay of over 6 months between PNES onset and Minnesota Epilepsy Group diagnostic evaluation were much more likely to have had prior extensive evaluations for their PNES symptoms (X2= 9.94, p=.002), but had not sought treatment. PNES frequency at time of comprehensive diagnostic evaluation was more than 1 per week for the majority of patients (49/62). PNES episodes lasted greater than 5 minutes for 43/62 patients. Most patients (46/62) at evaluation reported a warning sign that PNES was imminent at least several seconds prior to onset (dizziness, heart racing, “yucky feeling,” headache). Histories of other impairing somatic complaints were present in a little more than half of the patients (34/62), with many also having prior psychiatric diagnoses (42/62). PNES symptoms were controlled after 12 sessions of outpatient psychotherapy in 70% (43/62) of the cases. In total 85% (54/62) patients achieved symptom control by termination of treatment. Two patients remained refractory to intervention and continued in treatment (well over one year). Treatment after management of PNES continued for more than half of the patients (36/62) to address the factors that provoked development of the PNES (psychiatric, familial, social, and cognitive). Conclusions: Although there is a significant need for a comprehensive treatment approach for patients with PNES, there have been few studies examining factors associated with diagnosis and treatment of pediatric patients. This preliminary study highlights the complexity of this disorder in children, the reduction and cessation in PNES symptoms in 85% of the patients, and the need for ongoing psychotherapy following PNES control. Future, prospective studies, should examine the factors that promote optimal management of symptoms, improve function, and treat the underlying factors that caused the development of the disorder. Funding: There is no funding to report