Abstracts

Rationale: Psychogenic non-epileptic seizures (PNES) in children is an understudied condition with severe medical and psychiatric morbidity, significant health-care service burden and high use of medical services and cost. There have been few studies examining diagnosis and treatment of children with PNES. The current study describes the diagnostic evaluation of PNES, the course of treatment and themes present throughout the course of therapy in a group of pediatric patients 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 include. All 38 patients (27 female) were also enrolled in psychotherapy immediately after diagnosis. Patients completed at least 2 follow-up psychotherapy appointments, but most completed at least 12. Data was extracted from semi-structured psychiatric interviews and therapy notes. Results: Mean age of PNES symptom onset was 13.6 years. The majority of patients (77%) were diagnosed within 6 months of onset of symptoms, with a range from 1 day to 1+ year. PNES frequency at diagnosis for most patients occurred weekly (74%), with cessation of symptoms occurring by session 12 for the majority of patients (76.3%). Symptom cessation was achieved by 92% of the patients by their final treatment session. Two groups emerged. Group 1 (12/38) discontinued treatment after symptom cessation. Group 2 (23/38) continued treatment past symptom cessation. Groups 1 and 2 were similar in pre-existing psychiatric diagnoses (65%), histories of epilepsy (26%) and presence of childhood adversities (86.8%): bullying (50%), witness family violence (37%), death of family/friend (32%) and much fewer with sexual (13%) or physical (2%) abuse. Group 1 was younger by 1 year (mean 13.3 v 14.4), and Group 2 was more likely to have waited longer for accurate diagnosis (25% over 1 year). Group 2 were twice as likely (60%) to have had a prior extensive evaluation for other somatic symptoms (GI, pain, cardiac, other neuro). Therapy focused on management of somatic symptoms initially, and evolved to focus on family functioning for those who stayed in therapy past symptom cessation. Conclusions: Although there is a significant need for a comprehensive treatment approach for patients with PNES, there have been few treatment 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 92% of the patients, and a shift in treatment focus to family-related factors only after symptom cessation. Future, prospective studies, should involve a manualized approach aimed at initially reducing somatic symptoms and then addressing factors that may underlie this disorder.