Abstracts

Rationale: The purpose of this study was to advance our understanding of PNES in children and adolescents cross-culturally. Accordingly, we compared various clinical characteristics of psychogenic nonepileptic seizures (PNES) among young patients from five countries. Methods: In this retrospective study, we compared consecutively referred patients diagnosed with PNES (confirmed by video-EEG) with age at onset of 16 years or younger, from epilepsy monitoring units in Iran, Brazil, the USA, Canada, and Venezuela. Age, gender, age at seizure onset, seizure semiology, predisposing factors, and video-EEG recordings of all patients were extracted and summarized descriptively for characterization. Pearson Chi-Square, one-way ANOVA and Bonferroni correction tests were used for statistical analyses. P values less than 0.05 were considered significant. Approval was obtained from the Institutional Ethics Board at each center prior to data collection.  Results: Two hundred forty patients were studied (88 from Iran, 53 from Brazil, 40 from Canada, 32 from the USA, and 27 from Venezuela). Age at onset of seizures was 11.7 ± 3.7 years (range: 1-16 years). The sex ratio of patients was 1.76 (153 girls:87 boys). Demographic variables of the patients and factors associated with PNES were largely similar among these five countries. There were, however, some statistically and clinically significant differences in seizure characteristics observed between the international samples. In particular, reported rates of pre-ictal aura presence (90% in Canada vs. 53% in USA), ictal loss of responsiveness (81% in Iran/Brazil vs. 55% in Canada), closed eyes (85% in Iran vs. 31% in USA), generalized motor seizures (84% in Iran vs. 30% in Venezuela), and ictal injury (27% in Iran vs. 6% in USA) varied widely among countries (p<.05). Specifically, more severe presentations (e.g. closed eyes, generalized motor seizures and ictal injury) were most frequently observed in the Iranian sample. Potential risk factors associated with PNES in children and adolescents in these five nations were broadly similar with the exception of academic failure, which lost its significance once Bonferroni correction was applied. Conclusions: This study underscores how international cross-cultural studies can make important contributions to our understanding of PNES. Young patients with PNES from different countries were similar on many demographic characteristics and risk factors associated with PNES, suggesting some universality among features. Differences were also noted however, with regard to seizure semiology, suggesting the potential influence of cultural factors including greater emotional repression and suppression. Funding: No funding