Children with psychogenic non-epileptic seizures (PNES): A detailed semiologic analysis and modified new classification

Dhiman, Vikas; Sinha, Sanjib; Rawat, Vikram Singh; Kommu, John Vijay Sagar; Thippeswamy, Harish; Srinath, Shobha; Chaturvedi, Santosh K.; Satishchandra, P

doi:10.1016/j.braindev.2013.05.002

Cited by 35 publications

(50 citation statements)

References 34 publications

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“…Pediatric PNES is often confused with epilepsy, and misdiagnosis and diagnostic delay for several years are commonly reported problems . Misdiagnosis leads to unnecessary investigations, invasive procedures, and improper treatment with antiepileptic drugs (AEDs) that may have harmful side effects, as well as considerable emotional and/or financial costs for the child, the family, and the health care system .…”

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confidence: 99%

Diagnostic practice of psychogenic nonepileptic seizures (PNES) in the pediatric setting

2014

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SUMMARYObjective: No formal guidelines for diagnosing psychogenic nonepileptic seizures (PNES) in children exist, and little is known about the clinical practice of diagnosing PNES in the pediatric setting. We therefore performed a national survey as a first step to document pediatricians' current diagnostic practice for PNES. Methods: A questionnaire was distributed to all pediatricians (n = 64) working in the field of neuropediatrics and/or social pediatrics in the Danish hospital setting to uncover their use of terminology and of the International Classification of Diseases, 10th Revision (ICD-10) codes as well as their clinical diagnostic approach to pediatric PNES. The questionnaire included questions on 18 history and 24 paroxysmal event characteristics. Results: The response rate was 95% (61/64). There was no consensus on which terminology and diagnostic codes to use. Five history characteristics (psychosocial stressors/ trauma, sexual abuse, paroxysmal events typically occur in stressful situations, no effect of antiepileptic drugs, and physical abuse) and six paroxysmal event characteristics (resisted eyelid opening, avoidance/guarding behavior, paroxysmal events occur in the presence of others, closed eyes, rarely injury related to paroxysmal event, and absence of postictal change) were agreed to be very predictive of PNES by at least 50% of the pediatricians. Supplementary diagnostic tests such as blood chemistry measurements (e.g., blood glucose or acute phase reactants; i.e., white blood cell count and Creactive protein) and electrocardiography were inconsistently used. Only 49% of the respondents reported to use video-electroencephalography (VEEG) frequently as part of their diagnostic procedure. Significance: To our knowledge, this is the first national survey that offers a systematic insight into the diagnostic practices for children with PNES in the hospital setting. The results demonstrate a need for clinical guidelines to improve and systematize the diagnostic approach for PNES in children.

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confidence: 99%

Diagnostic practice of psychogenic nonepileptic seizures (PNES) in the pediatric setting

2014

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“…In pediatric population, recent studies have identified a mean age of presentation of 10.5 years (Madaan et al, ) or older: 12.81 years (Valente, Alessi, & Vincentiis, ); 14.19 years (Say, Taşdemir, & İnce, ); 12.3 years (Dhiman et al, ); 11.6 years (Szabó et al, ); and 12.9 years (Patel et al, ). All these findings are in contrast with another study by Park et al who found a lower mean age, <6 years, at the time of diagnosis of PNES in 141 patients.…”

Section: Clinical Features Of Pediatric Pnesmentioning

confidence: 99%

“…A female predominance of PNES is seen in adults (67%–74%; An et al, ; Gröppel et al, ; Hubsch et al, ; Seneviratne et al, ), as well as in pediatric population (Anderson, Damianova, Hanekomb, & Lucas, ; Dhiman et al, ; Say et al, ; Valente et al, ). More recently, Madaan et al () found a male predominance (56.2% vs. 43.8%) in their sample of 80 patients with PNES.…”

Section: Clinical Features Of Pediatric Pnesmentioning

confidence: 99%

Psychogenic nonepileptic seizures in pediatric population: A review

et al. 2019

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IntroductionPsychogenic nonepileptic seizures (PNES) are observable abrupt paroxysmal changes in behavior or consciousness that resemble epileptic seizures, but without concurrent electroencephalographic abnormalities.MethodsIn this manuscript, we reviewed literature concerning pediatric PNES and focused on those articles published in the last 10 years, in order to try to understand what the state of the art is at the moment, particularly as regards relationship and differential diagnosis with epilepsy.ResultsPsychogenic nonepileptic seizures have been extensively described in literature mainly in adults and less frequently in children. Despite the potential negative impact of a misdiagnosis (unnecessary investigations and antiepileptic drugs, structured pathological behavioral patterns), in literature there is little information regarding the real prevalence, clinical features, treatment, and outcome of PNES in children and adolescents.ConclusionPsychogenic nonepileptic seizures are common but frequently missed entity in pediatric population. Diagnosis could be difficult, especially in those children who have both epileptic and nonepileptic seizures; video EEG and home video can help clinicians in diagnosis. More studies are needed to better classify PNES in children and facilitate diagnosis and treatment.

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“…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.…”

Section: Forekomstunclassified

“…Mange av barna får epilepsidiagnose og årelang behandling med antiepileptika. I en studie fra India var det tilfelle hos 33 av 56 barn med slike anfall (10). De som først får epilepsidiagnose, har gjerne laert at anfallene resulterer i økt oppmerksomhet, noe som kan vedlikeholde anfallstendensen.…”

Section: Diagnostikkunclassified