Paroxysmal nonepileptic events in a pediatric epilepsy clinic

Abstract

A BSTRACT Aims: We aimed to study the frequency, age, and gender distribution of paroxysmal nonepileptic events (PNEs) in children referred to epilepsy clinic with the diagnosis of epilepsy. We also evaluated the therapeutic implications of correct diagnosis and co-existence of true epilepsy in this population. Settings and Design: All new patients below 18 years attending the Pediatric epilepsy out-patient clinic of PD Hinduja hospital over 6 months were evaluated. Materials and Methods: Patients with history of paroxysmal events characterized by abrupt changes in consciousness or behavior or movement were included. They were assessed on description of events aided by recorded videos. If the diagnosis was not confirmed by this preliminary evaluation, further investigations were advised. Statistical Analysis Used: Chi-square/Fisher’s exact test was used to analyze differences between categorical variables and Kruskal–Wallis test between continuous variables. The data were analyzed by SAS University Edition. All significance tests were two-tailed with α <0.05. Results: Two hundred new patients presenting with paroxysmal events were enrolled over 6 months. After diagnoses, 19% of these children had PNEs, 80% had epileptic events, and 1% remained undiagnosed. Common nonepileptic events seen were physiological in patients below 5 years and psychogenic in older children. Thirty-four percent of patients with PNEs were on anti-epileptic drugs (AEDs). After confirming nonepileptic attacks, only 2.6% patients needed AEDs for coexisting epilepsy which was statistically significant ( P < 0.001) change in treatment. Conclusions: Epilepsy mimics are common in children and are often misdiagnosed causing undue stress. Correct diagnosis leads to a drastic change in management like withdrawal of drugs, commencing new treatment if needed, and appropriate referrals.

Treatment Provided in Children and Adolescents with Functional Seizures—A Danish Nationwide Cohort

“…Most patients without comorbid epilepsy discontinued ASMs; however, ASMs were either initiated or continued for 11 (3.8%) patients without comorbid epilepsy. Multiple studies have shown that treatment with ASMs is ineffective and can potentially lead to adverse learning and behavioural effects in patients without epilepsy [4,[26][27][28]. The results from the current study could reflect the results found in the study by Plioplys et al [29].…”

Paroxysmal non-epileptic events vs epilepsy – what we know and where we are in medicine?

“…Video recordings of seizures at home and provocations with a placebo test can be helpful in differentiating epileptic seizures from other disorders. 44,45 An important point to emphasise is that PNEEs often mimic non-epileptic seizures due to the similarity of clinical symptoms such as syncope, loss of consciousness, headache, vomiting, dizziness, irregular breathing or emotional and psychological problems. 1 There is no single specialised medication or treatment method specific to PNEEs that can help young patients.…”

The Impact of Self-Care Recommendations with and without Tilt-Training on Quality of Life in Children and Adolescents with Vasovagal Syncope: A Randomized Clinical Trial

“…A syncope event is associated with the premonitory phase and is characterized by non-specific symptoms such as dizziness, sweating, visual blurring, nausea, palpitations, pallor, weakness, and cold skin. [ 2 ] The symptoms can occur singularly or in combination for a few seconds to 1–2 minutes. [ 2 ] Syncope occurs more often in females than in males and is more common in both genders at the age of 15 years.…”

“…[ 2 ] The symptoms can occur singularly or in combination for a few seconds to 1–2 minutes. [ 2 ] Syncope occurs more often in females than in males and is more common in both genders at the age of 15 years. [ 3 ] Approximately 15.0% of children experience an episode of syncope before the end of the second decade of life, and 1.0% of common pediatric emergency complaints are related to syncope.…”