Abstracts

Rationale: Children with psychogenic nonepileptic seizures (PNES) often present with a multitude of physical, psychological and family stressors that may contribute to emergence of their symptoms. The etiology of PNES has been studied extensively in the adult literature, with comparable results emerging from the few pediatric studies (Wyllie, et. al., 1999). While much of the adult literature points to family of origin factors influencing the development of PNES, few studies have looked specifically at family composition, stressors, psychopathology or medical illness of pediatric patients presenting with PNES (Abubakr, et.al 2003; Tojek et al, 2000). The objective of the present investigation is to describe the individual child and family stressors present in a sample of pediatric patients diagnosed with PNES while hospitalized on an inpatient epilepsy monitoring unit. Methods: Records of 67 patients admitted to the pediatric epilepsy unit for the Minnesota Epilepsy Group at the Children’s Hospitals and Clinics, St. Paul from January 2004 through May of 2009, and who were subsequently diagnosed with PNES, were retrospectively reviewed. Patients were included if they were diagnosed with PNES by the attending pediatric neurologist, and were formally evaluated by a psychologist. For this study, stressors were obtained from parents, caregivers, the patient and review of their medical chart. Results: Of the 67 participants, 66% were female and 34% were male. The ages ranged from 8 to 18 years of age, with the average being 14-years-old. The majority identified multiple individual and family stressors. Individual child stressors included: academic challenges (47%), peer conflict or rejection (38%), victim of physical/sexual abuse (17%), “perfectionism” in academics or athletics (15%) and/or romantic relationship issues (13%). Additionally, children presented with pre-existing psychiatric diagnoses (71%), chronic medical illness (49%) and/or additional significant somatic complaints (19%). Family stressors identified included: parental conflict (24%), domestic violence (15%), recent family move (15%), death of a family member (13%) and significant sibling conflict (9%). Parents presented with histories of psychiatric diagnosis (60%) and/or chronic medical illness (33%). Siblings also presented with histories of psychiatric diagnosis (21%) and/or chronic medical illness (15%). Conclusions: Individual and family characteristics of children presenting with PNES illustrate the prevalence of academic challenges, peer conflict and family stressors within a sample from a regional epilepsy center. Additionally, the majority of the participants had histories of psychiatric or chronic medical conditions, as did a number of their parents and siblings. These preliminary results support previous findings that multiple individual and family stressors are present in children presenting with PNES. Further investigation is warranted into how these stressors impact presentation and treatment of PNES.