Sensitivity and specificity of induction of psychogenic non-epileptic seizures in children and adolescents

Abstract

The purpose of this study was to investigate the sensitivity and specificity of a standardized placebo protocol using a moist swab pad application in children and adolescents with psychogenic seizures vs epileptic seizures. Methods: We retrospectively reviewed clinical data and video-EEG monitoring records with the standardized placebo protocol of 408 patients. Video -EEG diagnosis with PNES-consistent semiology was made in the context of clinical data by a two-certified epileptologist. Results of induction of psychogenic seizure by moist swab pad application were analyzed in 158 patients with PNES. A control group was composed of 74 patients with epilepsy in which induction was performed. Results: Sensitivity of placebo test for the diagnosis of PNES was 81.1%, specificity 79.8%, positive predictive value 89.6% and negative predictive value 66.3%. Conclusion:The placebo technique with a moist swab can be regarded as helpful in triggering a psychogenic episode in children and adolescents.

The evaluation of psychogenic non-epileptic seizures (PNES) cases with saline injection method in video-EEG monitorization unit

“…The main purpose of induction tests is to support the diagnosis of PNES, decrease cost, and decrease the waiting time in VEM units 26 . Intravenous saline application, hyperventilation, photic stimulation, hypnosis or seizure provocation with suggestion methods have been used in many centers [27][28][29][30] .…”

Scoping review and expert‐based consensus recommendations for assessment and management of psychogenic non‐epileptic (functional) seizures (PNES) in children: A report from the Pediatric Psychiatric Issues Task Force of the International League Against Epilepsy

“…In terms of criteria used to define PNES, eight studies specifically mentioned DSM criteria, 47,53,56,60,63,65,81,93 seven ICD criteria, 30,31,33,48,49,55,86 and in six studies the minimum requirements outlined by La France 15 et al 2013 [29][30][31][32]34,37 were employed. Two studies required both La France et al and ICD criteria.…”

“…The use of provocation techniques involving physical manipulation was reported to have been used to elicit PNES in 11 of 77 studies (14%) 33,45,58,68,72,82,83,92,93,96,100 (see Table 5) in the scoping review. Some methods were used in more than one study.…”