Psychogenic Seizures in Children: Long-Term Analysis of 43 Cases

Abstract

Forty-three patients exhibiting psychogenic seizures with onset before the age of 16 years were studied. All patients underwent intensive electroencephalography and video-electroencephalography monitoring. Thirty-two were female and 11 male. Mean age of the population at seizure onset was 12.4 years (range, 5 to 16 years). Twenty-one patients (48.8%) were taking anticonvulsants. Neurologic past history was abnormal in nine cases. Family history of epilepsy was found in 15 cases (34.9%). Median seizure frequency was one seizure every 5 days. Clinical characteristics of the seizures varied. However, unresponsiveness with generalized violent and uncoordinated movements involving the whole body (n = 19) or with generalized trembling (n = 11) were the most common features. Neuropsychological testing, carried out in 22 cases, failed to show major abnormalities in most of the cases. Significant personal and family distress was found in most of the cases. An important impact on patient's quality of life was evident when the seizures were present as compared to the seizure-free periods. There were no statistically significant predictors of clinical outcome.

Psychogenic nonepileptic seizures in children and adolescents with epilepsy

“…As for gender distribution, the female predominance (66-99% of cases) is controversial, being reported in some pediatric population studies, 6,8 but not in others. 11,13 According to Pakalnis and Paolicchi, 13 11 (69%) of 16 were boys, suggesting that contrary to findings in the adult population, PNES is commonly seen in boys.…”

“…In the work of Lancman et al, 8 21 patients (48.8%) were taking anticonvulsants. The presence of a neurologic history frequently misguides the diagnosis, emphasizing that the presence of a previous neurologic history dos not exclude the occurrence of PNES.…”

“…8 A history of meningitis and arachnoid cyst were the most frequently encountered neurologic diseases in these patients history.…”

“…6,8,[16][17][18] Although it is uncommon, some patients at the age of 6 years or younger had true psychogenic seizures. The earlier age of onset seems to more evident when one analyses children with personal or family history of epilepsy.…”

“…PNES in children as it is the case in adults impair quality of life and lead to iatrogenic consequences. The work of Lancman et al, 8 showed that there was an important impact on patient's quality of life which was evident when the seizures were present as compared to the seizure-free periods.…”