Abstract
Context
Though psychogenic non-epileptic seizures (PNES) are seen commonly during evaluation of children and adolescents with epilepsy, the literature regarding developmental changes in PNES is limited.
Evidence Acquisition
Literature search was conducted in PubMed. Key search terms included: Pseudoseizure* OR PNES OR [(non-epileptic or nonepileptic or psychogenic or non-epileptic attack disorder) AND (seizure*)], resulting in 3,236 articles. Filters included human, ages 1–18 years, English language and last 15 years (2004–2019), resulting in 533 articles. We reviewed 33 articles, which included 19 articles that involved children (1–18 years), with 10 or more children with PNES in their study group. 21 articles obtained in cross references that were outside the filter setting (including time frame and age range) were also reviewed, for a total of 54 articles.
Results
Majority of the studies were retrospective. We detail clinical features, predisposing factors and appropriate workup for children and adolescents with possible PNES. There is no consensus regarding frequency of psychiatric comorbidities in children with PNES. No controlled trials of treatment of PNES in children are available, but cognitive behavioral therapy is the consensus for adult PNES. Outcome appears to be better in children with PNES.
Conclusions
There is a need for be long-term prospective studies to document various clinical features and outcome of pediatric and adolescent PNES, and also the comorbid conditions.
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References
Patel H, Scott E, Dunn D, Garg B. Nonepileptic seizures in children. Epilepsia. 2007;48:2086–92.
Szabo L, Siegler Z, Zubek L, et al. A detailed semiologic analysis of childhood psychogenic nonepileptic seizures. Epilepsia. 2012;53:565–70.
Lesser R. Psychogenic seizures. Neurology. 1996;46:1499–507.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.
The ICD-10 Classification of Mental and Behavioral disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organization:1992.
Gates JR. Epidemiology and classification of non-epileptic events. In: Gates JR, Rowan AJ, editors. Non-epileptic seizures. 2nd ed. Butterworth-Heinemann; 2011.p.3–14.
Benbadis SR, Allen Hauser W. An estimate of the prevalence of psychogenic non-epileptic seizures. Seizure. 2000;9:280–81.
Reuber M. Psychogenic nonepileptic seizures: answers and questions. Epilepsy Behav. 2008;12:622–35.
Holmes GL, Sackellares JC, McKiernan J, Ragland M, Dreifuss FE. Evaluation of childhood pseudoseizures using EEG telemetry and video tape monitoring. J Pediatr. 1980;97:554–58.
Kutluay E, Selwa L, Minecan D, Edwards J, Beydoun A. Nonepileptic paroxysmal events in a pediatric population. Epilepsy Behav. 2010;17:272–75.
Kim SH, Kim H, Lim BC, et al. Paroxysmal nonepileptic events in pediatric patients confirmed by long-term video-EEG monitoring—Single tertiary center review of 143 patients. Epilepsy Behav. 2012;24:336–40.
Bhatia MS, Sapra S. Pseudoseizures in children: A profile of 50 cases. Clin Pediatr (Phila). 2005;44:617–21.
Dhiman V, Sinha S, Rawat VS, et al. Children with psychogenic non-epileptic seizures (PNES): a detailed semiologic analysis and modified new classification. Brain Dev. 2014;36:287–93.
Madaan P, Gulati S, Chakrabarty B, et al. Clinical spectrum of psychogenic non epileptic seizures in children: An observational study. Seizure. 2018;59:60–66.
Vincentiis S, Valente KD, Thome-Souza S, Kuczinsky E, Fiore LA, Negrao N. Risk factors for psychogenic nonepileptic seizures in children and adolescents with epilepsy. Epilepsy Behav. 2006;8:294–98.
Valente KD, Alessi R, Vincentiis S, Santos BD, Rzezak P. risk factors for diagnostic delay in psychogenic nonepileptic seizures among children and adolescents. Pediatr Neurol. 2017;67:71–77.
Goldstein LH, Robinson EJ, Reuber M, et al. Characteristics of 698 patients with dissociative seizures: A UK multicenter study. Epilepsia. 2019;60:2182–93.
Davis BJ. Predicting nonepileptic seizures utilizing seizure frequency, EEG, and response to medication. Eur Neurol. 2004;51:153–56.
LaFrance WC, Jr., Reuber M, Goldstein LH. Management of psychogenic nonepileptic seizures. Epilepsia. 2013;54:53–67.
Plioplys S, Doss J, Siddarth P, et al. A multisite controlled study of risk factors in pediatric psychogenic nonepileptic seizures. Epilepsia. 2014;55:1739–47.
Wyllie E, Glazer JP, Benbadis S, Kotagal P, Wolgamuth B. Psychiatric features of children and adolescents with pseudoseizures. Arch Pediatr Adolesc Med. 1999;153:244–48.
Say GN, Tasdemir HA, Ince H. Semiological and psychiatric characteristics of children with psychogenic nonepileptic seizures: Gender-related differences. Seizure. 2015;31:144–48.
Verrotti A, Agostinelli S, Mohn A, et al. Clinical features of psychogenic non-epileptic seizures in prepubertal and pubertal patients with idiopathic epilepsy. Neurol Sci. 2009;30:319–23.
Plioplys S, Doss J, Siddarth P, et al. Risk factors for comorbid psychopathology in youth with psychogenic nonepileptic seizures. Seizure. 2016;38:32–37.
Asadi-Pooya AA, Al Baradie R, Sawchuk T, Bahrami Z, Al Amer A, Buchhalter J. Psychogenic nonepileptic seizures in children and adolescents: An international cross-cultural study. Epilepsy Behav. 2019;90:90–92.
Reuber M, Brown RJ. Understanding psychogenic nonepileptic seizures-phenomenology, semiology and the Integrated Cognitive Model. Seizure. 2017;44:199–205.
Vasta R, Cerasa A, Sarica A, et al. The application of artificial intelligence to understand the pathophysiological basis of psychogenic nonepileptic seizures. Epilepsy Behav. 2018;87:167–172.
Fogarasi A, Janszky J, Tuxhorn I. Ictal emotional expressions of children with partial epilepsy. Epilepsia. 2007;48:120–23.
Alessi R, Vincentiis S, Rzezak P, Valente KD. Semiology of psychogenic nonepileptic seizures: Age-related differences. Epilepsy Behav. 2013;27:292–95.
Chung SS, Gerber P, Kirlin KA. Ictal eye closure is a reliable indicator for psychogenic nonepileptic seizures. Neurology. 2006;66:1730–31.
Burneo JG, Martin R, Powell T, et al. Teddy bears: An observational finding in patients with non-epileptic events. Neurology. 2003;61:714–15.
Vossler DG, Haltiner AM, Schepp SK, et al. Ictal stuttering: A sign suggestive of psychogenic nonepileptic seizures. Neurology. 2004;63:516–19.
Chabolla DR, Shih JJ. Postictal behaviors associated with psychogenic nonepileptic seizures. Epilepsy Behav. 2006;9:307–11.
Kramer U, Carmant L, Riviello JJ, et al. Psychogenic seizures: Video telemetry observations in 27 patients. Pediatr Neurol. 1995;12:39–41.
Benbadis SR, Johnson K, Anthony K, et al. Induction of psychogenic nonepileptic seizures without placebo. Neurology. 2000;55:1904–05.
Benbadis SR, Siegrist K, Tatum WO, Heriaud L, Anthony K. Short-term outpatient EEG video with induction in the diagnosis of psychogenic seizures. Neurology. 2004;63:1728–30.
Reilly C, Menlove L, Fenton V, Das KB. Psychogenic nonepileptic seizures in children: A review. Epilepsia. 2013;54:1715–24.
Chen DK, So YT, Fisher RS. Use of Serum Prolactin In Diagnosing Epileptic Seizures: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2005; 65: 668–75.
Dogan EA, Unal A, Unal A, Erdogan C. Clinical utility of serum lactate levels for differential diagnosis of generalized tonic-clonic seizures from psychogenic nonepileptic seizures and syncope. Epilepsy Behav. 2017;75:13–17.
Wyllie E, Lueders H, Pippenger C, VanLente F. Postictal serum creatine kinase in the diagnosis of seizure disorders. Arch Neurol. 1985;42:123–26.
Ceylan M, Yalcin A, Bayraktutan OF, Laloglu E. Serum NT-pro CNP levels in epileptic seizure, psychogenic non-epileptic seizure, and healthy subjects. Neurol Sci. 2018;39:2135–39.
Goodman R, Ford T, Richards H, Gatward R, Meltzer H. The development and well-being assessment: Description and initial validation of an integrated assessment of child and adolescent psychopathology. J Child Psychol Psychiatry. 2000;41:645–55.
Plioplys S, Asato MR, Bursch B, Salpekar JA, Shaw R, Caplan R. Multidisciplinary management of pediatric nonepileptic seizures. J Am Acad Child Adolesc Psychiatry. 2007;46:1491–95.
McFarlane FA, Allcott-Watson H, Hadji-Michael M, et al. Cognitive-behavioral treatment of functional neurological symptoms (conversion disorder) in children and adolescents: A case series. Eur J Paediatr Neurol. 2019;23:317–28.
Sawchuk T, Buchhalter J, Senft B. Psychogenic nonepileptic seizures in children-prospective validation of a clinical care pathway and risk factors for treatment outcome. Epilepsy Behav. 2020;105:106971.
LaFrance WC Jr, Baird GL, Barry JJ, et al. Multicenter pilot treatment trial for psychogenic nonepileptic seizures: a randomized clinical trial. JAMA Psychiatry. 2014;71:997–1005.
Goldstein LH, Robinson EJ, Mellers JDC, et al. Cognitive behavioral therapy for adults with dissociative seizures (CODES): A pragmatic, multicenter, randomized, controlled trial. Lancet Psychiatry. 2020;7:491–505.
Wyllie E, Friedman D, Luders H, Morris H, Rothner D, Turnbull J. Outcome of psychogenic seizures in children and adolescents compared with adults. Neurology. 1991;41:742–44.
Chinta SS, Malhi P, Singhi P, Prabhakar S. Clinical and psychosocial characteristics of children with nonepileptic seizures. Ann Indian Acad Neurol. 2008;11:159–63.
Yadav A, Agarwal R, Park J. Outcome of psychogenic nonepileptic seizures (PNES) in children: A 2-year follow-up study. Epilepsy Behav. 2015;53:168–73.
Yilmaz U, Serdaroglu A, Gurkas E, Hirfanoglu T, Cansu A. Childhood paroxysmal nonepileptic events. Epilepsy Behav. 2013;27:124–49.
Salpekar JA, Plioplys S, Siddarth P, et al. Pediatric psychogenic nonepileptic seizures: a study of assessment tools. Epilepsy Behav. 2010;17:50–55.
Kacinski M, Leskiewicz M, Jaworska-Feil L, et al. Pseudo-epileptic seizures in children are not associated with enhanced plasma level of allopregnanolone. Pharmacol Rep. 2007;59:683–90.
Uldall P, Alving J, Hansen LK, Kibaek M, Buchholt J. The misdiagnosis of epilepsy in children admitted to a tertiary epilepsy center with paroxysmal events. Arch Dis Child. 2006;91:219–21.
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Patel, H., Blake, H. & Dunn, D. Psychogenic Nonepileptic Seizures in Children and Adolescents. Indian Pediatr 58, 259–265 (2021). https://doi.org/10.1007/s13312-021-2167-9
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DOI: https://doi.org/10.1007/s13312-021-2167-9