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Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
d
Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
b
c
A R T I C L E I N F O
A B S T R A C T
Article history:
Received 29 May 2014
Received in revised form 24 September 2014
Accepted 26 September 2014
Purpose: To assess the psychiatric diagnoses and outcome in children with psychogenic non-epileptic
seizures (PNES).
Methodology: This hospital based observational study was performed on 44 children aged <16 years,
who suspected to have psychogenic non-epileptic seizures based on video-EEG, from August 2005 to
August 2012. The parameters noted were the psychiatric diagnosis, co-morbidities, management
assessment and interventions (pharmacological and psychosocial), number and duration of follow-up
visits, symptoms at follow-up, functioning as reflected by involvement in the social and scholastic work.
Results: All forty four children completed the evaluation. Thirty four children were diagnosed as having
PNES and the underlying psychiatric diagnosis was conversion disorder (n = 34, 77.3%). Co-morbid
psychiatric disorders were present in 17 children (50%). The common co-morbidities were intellectual
disability (n = 8, 23.5%), specific learning disorder (n = 5, 14.7%), and depression (n = 5, 14.7%). Co-morbid
epilepsy was present in 8 (23.5%) children and family history of epilepsy was present in 10 (29.4%) cases.
About 17 of 34 (50.0%) patients had a minimum follow-up of 6 months (13.9 ! 4.8 months). Twenty six
children (76.5%) remained symptom free at the follow-up of 9.8 ! 7 months. The remaining 10 children
(22.7%) had non-epileptic seizures with underlying diagnosis of Attention Deficit Hyperactivity Disorder
(ADHD), gratification disorder and other physiological conditions.
Conclusions: Conversion disorder is a common diagnosis underlying psychogenic non-epileptic seizures.
Outcome was good in 76.5% children with PNES. A multidisciplinary approach is needed in the diagnosis
and management of PNES.
! 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
Keywords:
Non-epileptic
Outcome assessment seizures
Pediatric
Psychogenic
1. Introduction
Psychogenic non-epileptic seizures (PNES) are involuntary time
limited events that may manifest as motor, sensory or behavioral
phenomena resembling true seizures.13 Clinically, when a nonepileptic event is suspected, it is prudent to reassess the clinical
history and evaluate for the possible causes of the paroxysmal
events like psychiatric problems, migraine, syncope, periodic
http://dx.doi.org/10.1016/j.seizure.2014.09.011
1059-1311/! 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Rawat VS, et al. Co-morbidities and outcome of childhood psychogenic non-epileptic seizuresAn
observational study. Seizure: Eur J Epilepsy (2014), http://dx.doi.org/10.1016/j.seizure.2014.09.011
G Model
Please cite this article in press as: Rawat VS, et al. Co-morbidities and outcome of childhood psychogenic non-epileptic seizuresAn
observational study. Seizure: Eur J Epilepsy (2014), http://dx.doi.org/10.1016/j.seizure.2014.09.011
G Model
Table 1
Socio-demographic details of children with PNES.
Patient-related characteristics in PNESs (n = 34)
N (%)
Education
Preschool or primary school
High school
Pre-university
Positive history of anxiety disorder
Positive history of mood disorder
Positive history of self-harm
Positive family history of seizures
Positive family history of psychiatric disorders
Co-existent neurological deficit
Coexistent systemic complaint
Headache
19
13
2
4
4
4
7
3
4
9
5
(55.9)
(38.2)
(5.9)
(11.8)
(11.8)
(11.8)
(20.6)
(8.8)
(11.8)
(26.5)
(14.7)
Table 2
Details of psychiatric diagnosis among children.
Diagnosis (total = 44)
PNES
Conversion disorder
Other diagnosis
Attention Deficit Hyperactivity Disorder (ADHD)
Gratification disorder
Specific learning disorder
Night terrors
Hypersomnolence
Cold precipitating dyskinesia
Isovaleric aciduria
N (%)
34 (77.3)
3
2
1
1
1
1
1
(6.8)
(4.5)
(2.3)
(2.3)
(2.3)
(2.3)
(2.3)
5. Discussion
Please cite this article in press as: Rawat VS, et al. Co-morbidities and outcome of childhood psychogenic non-epileptic seizuresAn
observational study. Seizure: Eur J Epilepsy (2014), http://dx.doi.org/10.1016/j.seizure.2014.09.011
G Model
Funding
None.
Conflict of interest
None declared.
Acknowledgements
We acknowledge the contributions of the staffs of the epilepsymonitoring unit, Department of Neurology. Last but not the least,
we are grateful to the subjects for allowing us to carry out such
study.
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Please cite this article in press as: Rawat VS, et al. Co-morbidities and outcome of childhood psychogenic non-epileptic seizuresAn
observational study. Seizure: Eur J Epilepsy (2014), http://dx.doi.org/10.1016/j.seizure.2014.09.011