Abstracts

Rationale: Psychogenic nonepileptic seizures (PNES) are episodes similar to epilepsy that are not accompanied by abnormal electrical activity in the brain. Underdiagnosis of this pathological condition has great impact over the children s health. Risk factors are assumed to be similar to those observed in adults. In addition, semiology of PNES in children has been poorly described, but appears to be different from that reported in adults, especially in younger children. Methods: We performed a review of medical records and video-EEGs of 44 patients under 18 years with diagnosis of PNES confirmed by VEEG. Patients were categorized into semiologic groups according to the main characteristics of their episodes:i. generalized motor activity, ii.focal motor activity,iii.behavioral changes, iv. aura-like symptoms, and v.unresponsiveness. Patients with both epilepsy and PNES were also characterized as mimicking or not their own seizures. Classical indicators (ictal eye closure, pelvic thrusting, stuttering) of PNES in adults were also investigated. Results: Out of 44 patients (52.3% boys), with a median age of 12.6 yrs (SD 3.6), four patients were younger than 6 yrs,16 patients were aged between 7-13 yrs and 24 were older than 13 yrs. Considering age-differences, frequency of boys was higher (2.4 m:1 f) in patients younger than 10 years while the opposite was observed in older (1 m: 1.7 f). Mood disorders were present in 13 (29.5%). Epilepsy was diagnosed in 31 (72.7%) patients. Family history of epilepsy was reported in 47.4% and psychiatric disorders in 58.8%. History of physical and sexual abuse occurred in 18.2% and psychological abuse in four patients (9.1%). Inadequate family setting was detected in 29.5%.Generalized motor activity was the most common type (49.4%), followed by unresponsiveness (29.5%). Behavioral change (6.8%), aura-like (4.5%) and focal motor activity (4.5%) were less frequently observed. There was no significant difference in semiology between younger (< 10 ys) and older children, but the older children presented more prominent motor activity and more unresponsiveness while subtle motor activity occurred more often in the younger children. Among the 44 patients, only one closed her eyes during the seizure and merely two presented pelvic thrusting. Stuttering, tongue laceration and weeping were not observed. Of the 32 patients with epilepsy, 12 mimicked their own seizures. Conclusions: Adolescents are at higher risk for PNES, although it may occur in younger children. Girls represent a risk group only in older ages, and gender-correlation is not observed in younger children. Mood disorders, personal and family history for epilepsy were predictors of PNES. Inadequate family setting was more relevant than abuse, contradicting what is observed in adults. Semiology of PNES in our group was different from that described in adults. An age-related difference was observed as to type of motor activity. Moreover, classical signs such as ictal eye closure and pelvic thrusting were not reliable indicators of PNES in children.