Abstracts

Rationale: Pediatric patients present to the Epilepsy Monitoring Unit (EMU) for evaluation of episodes thought to be seizure. Of these admissions, close to 20% of the patients have psychogenic non-epileptic seizures. It is necessary for both diagnostic and treatment purposes that both children with epilepsy (ES) and those with psychogenic non-epileptic seizures (PNES) receive a thorough medical and psychological evaluation. Epileptic patients are at greater risk for psychiatric comorbidities such as anxiety and depression, and non-epileptic patients often have histories of psychiatric disorders that have often been undiagnosed and untreated. There are no known studies examining similarities and differences in patient characteristics at onset for both epileptic and psychogenic non-epileptic patients. This study sought to examine these factors in a sample of patients who presented for new onset “spells” to the Minnesota Epilepsy Group. Methods: Patients were chosen from two separate database that track non-epileptic and epileptic patients. Inclusion criteria for enrollment in study: 1. New onset (within 6 months of evaluation), 2. Aged 8-18 years, 3. “Spells” in question were captured via video EEG monitoring, 4. Evaluation at onset by pediatric psychologist. 121 patients met inclusion criteria. 59 (46 female) patients were diagnosed with PNES, 62 (28 female) were diagnosed with ES. Completed psychological evaluations including: semi-structured psychiatric interview of parent and child and completion of screening measures. Results: Time from onset to evaluation was less than 3 months for ES patients (82%) as compared to PNES patients (64%). Frequency of spells was significantly less for ES patients with only 22% experiencing more than 6 life time seizures and 62% of PNES patients experiencing more than 1 per week at onset. Of the PNES patients 9 experienced more than 1 per day, with only 3 patients with ES experiencing daily seizures. 8 ES patients (12%) and 41 PNES patients (69%) had histories of prior psychiatric diagnoses. 1 ES patient and 29 PNES patients (49%) had experienced suicidal ideation or thoughts of self harm. 24 ES (38%) and 59 PNES (100%) were recommended mental health treatment following formal evaluation for their spells due to confirmed psychiatric diagnoses impairing functioning. Conclusions: Pediatric patients presenting with new onset spells were analyzed to assess for similarities and differences in initial presentation. Consistent with prior studies, both populations of patients present with comorbid psychiatric disorders and varying degrees of prior assessment and treatment for these disorders. In this age-matched sample, patients with non-epileptic seizures were more likely to have more frequent spells at onset than their ES counterparts. They also were more likely to have prior histories of psychiatric diagnoses and presented with more psychiatric concerns. Suicidal ideation or self-harm was a very common and a distinguishing factor in the PNES sample, as compared to the patients with ES. This study helps inform both the importance of evaluation to all patients presenting with new onset spells, as well as highlights the significant comorbid mental health features in both patient populations.   Funding: No funding was received.