Abstracts

Rationale: Studies of adults report certain clinical characteristics of seizures such as eye closure, side-to-side or alternate limb movements, hyperventilating, crying, etc. suggest a higher probability of psychologically based nonepileptic seizures. However, there is very little literature on the clinical characteristics of psychogenic non-epileptic seizures in children. We have described the clinical characteristics of PNES in children compared to those reported in the adult literature. Methods: Following IRB approval, chart audit was performed to identify children given the diagnosis of PNES by video-EEG and psychological evaluation. Children 13 y.o. or younger were included in the study if a complete video-EEG of their events had been obtained during the inpatient epilepsy unit evaluation. Video-EEGs of the events were reviewed for 23 separate features attributed to PNES in adults. Results: There were 20 children, 12 female, 8 male, mean age 11.45 years (range 8 - 13). 36 events were evaluated. All 20 had at least 1 event with unresponsiveness. Sixty percent (12) of children had 4 or more characteristics to suggest PNES. In this group, 60% had gradual onset of arrhythmic jerking, 50% had side-to-side movements, 45% seizures with eyes closed, 40% out-of-phase extremity movement, 35% had large variability in seizure expression from one event to the next one, 30% at least one seizure over 2 minutes, and 10% had pelvic thrusting or crying. Only 1 patient had events with no features typical of PNES, 3 other patients had only 1 feature. Conclusions: PNES in children may share some of the clinical characteristics seen in adults. When the more common clinical features of PNES in adults are reported or observed in children, it should raise ones awareness to the possibility that the events actually may be PNES.