A detailed semiologic analysis of childhood psychogenic nonepileptic seizures

Abstract

SUMMARYPurpose: Psychogenic nonepileptic seizure (PNES) is an important differential diagnostic problem in patients with or without epilepsy. There are many studies that have analyzed PNES in adults; currently, however, there is no systematic assessment of purely childhood PNES semiology. Our study based on a large pediatric video-electroencephalography (EEG) monitoring (VEM) cohort, provides a detailed analysis of childhood PNES and assesses the usability of the current classification system described in adults. Methods: Medical and video-EEG records of 568 consecutive children (younger than 18 years) who underwent video-EEG monitoring (VEM) at our hospital were reviewed. Aura, type of movement, anatomic distribution, synchrony, symmetry, eye movement, responsiveness, vocalization, hyperventilation, vegetative and emotional signs, presence of eyewitness, and duration of the event were recorded among children with the diagnosis of PNES. We also compared our data with those of earlier adult studies. Key Findings: Seventy-five archived PNES of 27 children (21 girls; age 8-18 years) were reanalyzed. Nine children (33%) had the diagnosis of epilepsy currently or in the past. Mean age at the time of PNES onset was 11.6 (standard deviation 3.2) years. Mean duration of PNES was longer (269 s) compared to seizures of the epileptic group (83 s; p = 0.002). Eyewitnesses (mostly parents) were present in 89% of cases. Eighty percent of PNES had an abrupt start, with 68% also ending abruptly. In only 15% of events were the patients eyes closed at the beginning of the attack.Patients were unresponsive in 34%. The most frequent motor sign was tremor (25%) with the upper, rather than lower limbs more frequently involved. Pelvic thrusting was seen in only two attacks. Emotional-mostly negative-signs were observed during 32 PNES (43%). Based on Seneviratne et al.'s classification, 18 events (24%) were classified as rhythmic motor PNES, only half the frequency of that previously described in adults. No hypermotor PNES was found. The frequency of complex motor PNES (13%) and mixed PNES (4%) showed similar frequency in children as in adults. Dialeptic PNES was found more frequently among younger children. All PNES belonged to the same semiologic type in 23 patients (85%). Significance: Because homogeneity of PNES within a patient was high in the pediatric population, we found it useful to classify PNES into different semiologic categories. Dialeptic PNES seems to be more frequent among younger children. Tremor is the most frequent motor sign and usually accompanied by preserved responsiveness in childhood. Negative emotion is commonly seen in pediatric PNES, but pelvic thrusting is a rare phenomenon. We, therefore, suggest a modification of the present classification system in which PNES with motor activity is divided into minor and major motor PNES, and the latter group is subdivided into synchron rhythmic motor and asynchron motor PNES. We believe that our study, a detailed analysis on the semiology and classification of purely ch...

Psykogene ikke-epileptiske anfall hos barn

“…Første anfall opptrer som oftest i 8 -15-års-alderen (10,12,13), men diagnostiseringen er gjerne forsinket (10,14). Tilstanden er sett hos barn helt ned til 4 -5-årsalderen.…”

“…I materialer bestående av barn henvist til video-EEG for en diagnostisk utredning av forskjellige typer anfall, har man funnet tilstanden hos 3,5 -20 % (12,16,17). Blant barn henvist til pediatriske epilepsisentra for intraktabel epilepsi er det funnet en forekomst av barn med slike anfall på 10 -23 % (8,18).…”

“…En pediatrisk studie viste en gjennomsnittlig varighet av psykogene ikke-epileptiske anfall på 269 sekunder mot 83 sekunder for epileptiske anfall (12).…”

Pszichogén nem epilepsziás rosszullétek a klinikai gyakorlatban

“…A kórkép jellemzően 15-35 éves kor között veszi kezdetét, de kisgyermekkorban és időskorban is kialakulhat [12,15,16]. A fiatalabb korban kezdődő PNER eseté-ben gyakoribb a betegnél vagy családtagjánál diagnosztizált epilepszia, és többször kapunk beszámolót korábbi bántalmazásról is.…”

“…Dikmen és mtsai vizsgálatában a pszichogén rohamok átlagidőtartama 241 másodperc volt, a betegek 40-45%-ánál pedig a 300 másodpercet is meghaladta [26]. A pszichogén rohamok szemiológiai jellemzői alapján tör-ténő osztályozására több kísérlet is született, amelyek során a domináns tüneteket vették alapul egy-egy alosztály megalkotására (1. táblázat) [15,[27][28][29][30][31]. A rohamok szubjektív megélésében ugyancsak találunk különb-séget a PNER-és epilepsziás betegek között.…”