Nonepileptic Events in Childhood

Abstract

The medical records of 27 children admitted to the MINCEP Epilepsy Program for evaluation of intractable epilepsy but later shown to have nonepileptic events by EEG with simultaneous video monitoring were reviewed. Four groups were identified: pure psychogenic events (5 patients), psychogenic events plus epileptic seizures (3 patients), pure nonepileptic physiologic events (5 patients), and nonepileptic physiologic events plus seizures (14 patients). Historical data, physical examinations, and neurodiagnostic evaluations (including previous EEGs, neuroradiologic evaluations, and neuropsychologic testing) were reviewed. Children in all groups, except for those with pure psychogenic seizures, had a history of multiple seizure types identified by parents or caretakers. A history of status epilepticus was obtained in 64% (of 22 patients), including 11 of 14 patients with physiologic events plus seizures. Abnormal findings on neurologic examination were common, especially in children with nonepileptic physiologic events. All but two patients had a history of interictal epileptiform abnormalities on previous routine EEGs. Based on identification of nonepileptic events, antiepileptic drugs (AEDs) were discontinued completely in eight patients (30%) and the total number of AEDs was reduced in nine others (33%). A diagnosis of nonepileptic events should be considered in all children with refractory seizures or multiple seizure types. Abnormal findings on routine (interictal) EEG may actually confound the diagnosis. Intensive neurodiagnostic EEG-video recording is the preferred method for distinguishing nonepileptic from epileptic seizures.

The importance of acknowledging clinical uncertainty in the diagnosis of epilepsy and non-epileptic events

“…The epilepsies can be described using the multi axial classification of the International League Against Epilepsy task force. 18 The term non-epileptic event 8 describes the clinical area sometimes called ''funny turns'' and includes a wide variety of recognisable clinical entities. 12 13 We have used this in preference to ''turns'' or ''funny turns'' which might be perceived as trivialising the patients' concerns.…”

“…Such cases are common in clinical practice but under-represented in the literature, which often describes the epidemiology of confirmed cases of epilepsy [2][3][4][5] or describes misdiagnoses of epilepsy in children with non-epileptic conditions. [6][7][8][9] These themes in the literature may give clinicians the impression that all attacks should be classified either as epileptic or non-epileptic. We believe that this is a factor contributing to high rates of misdiagnosis-up to 30% in some series.…”

Clinical Reasoning: Shuddering attacks in infancy

“…This misdiagnosis may lead to unnecessary anticonvulsive treatment. 5 Therefore, EEG is advocated in all patients and ictal video documentation should always be attempted by caregivers. In cases with unusual clinical presentations, prolonged video EEG monitoring is helpful.…”

Psychological Interventions for Psychogenic Non-Epileptic Seizures (Pnes)

“…La cronicidad y complejidad de los problemas psicológicos y psiquiátricos, como depresión, trastorno disociativo, trastorno de la personalidad e historia de abusos crónicos, se relacionan con un peor pronóstico (Kuyk et al, 1997;Frances, Baker y Appleton, 1999). Existe una correlación negativa entre el tiempo de evolución de las CNEP y el pronóstico, por lo que el diagnóstico correcto y la instauración de un tratamiento precoz podrían determinar en gran medida la evolución de este sín-drome (Metrick et al, 1991;Martin et al, 1998).…”