Abstracts

Frequency of non-epileptic seizures in adults ranges between 17-30% (Lancman et al. 2001). Golden et al. (1985) found that 19% of adolescents with new-onset seizures had non-epileptic events. Several studies demonstrated two peaks: during adolescence and early adulthood. However, it must be emphasized that there is lack of data on children with psychiatric disorders, suggesting that children with non-epileptic events remain underdiagnosed. This study aimed to evaluate patients with psychogenic non-epileptic seizures (PNES) considering type, frequency and risk factors in order to enable early diagnosis and treatment, consequently avoiding iatrogenic complications. All patients were referred to the Unit for Research and Diagnostic of Epilepsy and Psychiatric Disorders in Childhood. Seizures and epileptic syndromes were classified according to ILAE criteria. Patients were evaluated with a structured psychiatric anamnesis and classified according to DSM IV, CID 10 and KIDDIE-SADS. Risk factors such as head trauma; emotional, physical and/or sexual abuse; psychiatric diagnoses and previous history of epilepsy were investigated by review of medical records and/or follow-up interviews. From a group of 69 patients (53.6%, male),with ages from 4 to18 years, we prospectively identified 20 (29%) children and adolescents under 18 years with a diagnosis of PNES, 12 of whom diagnosed by VEEG, and the remaining by direct observation of non-epileptic events. Ten patients were female. Two patients were under 6 years, 9 between 7 and 13 years, and 11 over 13 years. Mean age was of 12.8 years (SD 4.32). As to psychiatric diagnoses, 14 patients (70%) presented mood disorders (depression-anxiety), of which four with other associated diagnoses (3 with oppositional disorder and one with personality disorder), 3 (15%) with pure dissociative disorders, 2 (10%) with ADHD and one (5%) with oppositional disorder. History of abuse occurred in 3 cases. Eighteen patients (90%) had epilepsy (7 symptomatic, 9 cryptogenic, and 2 idiopathic) and eight patients(40%) had family history of epilepsy. It is assumed that children have a lower risk for PNES than adults (Sahlholdt et al. 1993), leading to under diagnosis and consequent inadequate therapeutic approaches. Among our 20 patients with PNES the most common psychiatric diagnosis was depression. Personal and family history of epilepsy were strongly related factors. Patients in late childhood and adolescence had a higher risk for NES than younger children, although the latter could not be excluded . These features may identify a population in need of adequate therapy and may point out a risk for a long lasting pathology.