Abstracts

Rationale: To characterize a sample of youth with psychogenic non-epileptic seizures (NES) and describe longitudinal NES outcome.Methods: First, a computerized database search was performed to identify subjects with NES amongst all 6-18 years old patients examined at the Epilepsy Monitoring Unit (EMU) from 2001 to 2005 at Children’s Memorial Hospital. Then, retrospective chart review was conducted to obtain data on demographics, stressors, comorbid medical, neurological and psychiatric illnesses, and NES. Finally, telephone follow-up interviews were completed with the families of youth with a history of NES for data update. Descriptive statistics and frequencies were calculated. Results: Results: 44 subjects with NES were identified. Sample consisted of 27 girls (61%) and 17 boys (39%), mean age 12.7±3.0; White (N=32; 73%), Black (N=2; 5%), Hispanic (N=7; 16%), and other (N=3; 6%) subjects. 15 families reported ongoing stressors with family stress as most common. The most common NES clinical features were random limb and body jerking (N=38; 86%). Comorbid epilepsy was found in 8 (18%) patients. Twenty (43%) patients were taking AEDs. Thirty-three (70%) children had comorbid general medical illnesses. 31 patients (70%) received a psychiatric evaluation while at the EMU, out of which 19 patients (61.3%) were diagnosed with ongoing psychopathology. Conversion was most commonly identified, followed by depression and anxiety disorders. Telephone follow-up interviews were completed for 26 (59%) (mean age 16.27±3.41) of the 44 patients with a history of NES; White (N=21; 81%), Hispanic (N=3; 11%), and Black (N=2; 8%). Nine families (35%) reported ongoing stressors with family problems as most common. 3 patients (11%) had ongoing epilepsy, 9 (35%) had general medical conditions, 13 (50%) had psychiatric problems. Total of 18 cases (69%) had resolved NES and 8 (31%) continuing. Those with ongoing NES were 5 girls (62.5 %) and 3 boys (37.5%) with mean age 16.87±3.36; 6 were White (75%), 1 Black (12.5%) and Hispanic each (12.5); 1 case had epilepsy, 4 (50%) had concurrent general medical problems, 5 (63%) had psychiatric issues. The duration of the NES ranged from 6 to 1 years, with 3 patients (37.5%) experiencing NES for 1 year. At the telephone follow-up, 5 cases (63%) with ongoing NES had psychopathology compared to 7 (88%) at the baseline. Similarly, 5 cases (63%) reported medical/neurological problems compared to 8 (25%) at the baseline. In a sample of youth with resolved NES, 6 (39%) had psychopathology at the follow-up compared to 11 (61%) at the baseline; 7 cases (31%) had medical problems at the follow up compared to 11 (61%) at the baseline. Conclusions: White adolescent girls may be at-risk for NES when a family stress is present. High rates of concurrent general medical illnesses and psychopathology may contribute to the development and persistence of NES over time.