Abstracts

Rationale: To study the proportion of paroxysmal non epileptic events in pediatric patients presenting with history of paroxysmal events in epilepsy clinic.To determine the age  and sex distribution of these eventsTo evaluate the therapeutic implications of correct diagnosis (modification/ withdrawal of drugs).To determine the co-existence of true epilepsy in this population. Methods: All new patients from zero to 18 years of age attending the Pediatric epilepsy clinic  were included if they presented with history of paroxysmal events characterized by abrupt changes in consciousness or behaviour or movement of limbs, body or eyes. Patients were assessed for the diagnosis of paroxysmal events based primarily on detailed history of events and clinical evaluation by pediatric neurologists at the hospital, sometimes aided by recorded videos of these events. If the diagnosis was not confirmed by this preliminary evaluation, further investigations like EEG/ video EEG, ECG and neuroimaging were advised.  Results: In this study of 200 new patients presenting with paroxysmal events in the pediatric epilepsy clinic, 19%  had non epileptic events, 80% had epileptic events, and 1% remained undiagnosed. Physiological or organic non epileptic events were more common in patients less than 5years of age and psychogenic non epileptic events were more common in more than 5years of age. Syncope was more common in adolescents. There was no statistically significant gender predilection for different paroxysmal non epileptic events. 34.2% of patients with non epileptic events were on AEDs.  After confirming non epileptic attacks, only 2.6% patients needed AEDs for coexisting true epilepsy. 31.6% of patients had received unnecessary AEDs. The change in treatment with correct diagnosis was statistically significant (p = 0.0001). Conclusions: Mimickers of epilepsy are common in pediatric practice and are often a cause of drug refractoriness and side effects of antiepileptic drugs (AEDs) and mental and financial burden to entire family. Correct diagnosis leads to correct management, commencing new treatment for the specific diagnosis if needed and appropriate referrals to other health care providers as indicated (cardiologist, psychiatrist, etc).  Funding: NONE