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Psychogenic non-epileptic seizures: management and prognosis
K Irwin1, M Edwards, R Robinson
1Paediatric Neurology Department, Newcomen Centre, Guy's Hospital, London SE1, UK. cjgroves@lineone.net
Insights
Children with psychogenic non-epileptic seizures (PNES) show promising outcomes, with most experiencing seizure freedom or significant reduction after intervention. Early identification and tailored treatment plans improve prognosis in pediatric PNES cases.
Area of Science:
- Pediatric Neurology
- Child Psychiatry
- Neuropsychology
Background:
- Psychogenic non-epileptic seizures (PNES) are a significant challenge in pediatric neurology.
- Understanding the prognosis and contributing factors in pediatric PNES is crucial for effective management.
Purpose of the Study:
- To determine the long-term outcome for children diagnosed with PNES.
- To identify factors that predict successful treatment and remission in pediatric PNES.
Main Methods:
- Retrospective review of medical records for 35 children diagnosed with PNES at a tertiary pediatric neurology center.
- Evaluation of seizure frequency, co-occurring epilepsy, psychosocial factors, and treatment interventions.
- Mean follow-up period of 4.6 years.
Main Results:
- Encouraging outcomes observed, with 66% of children becoming seizure-free and an additional 23% experiencing a >50% reduction in PNES frequency.
- PNES was diagnosed alone in most cases, with common contributing factors including abuse, anxiety, family dysfunction, and behavioral issues.
- Children without co-existing epilepsy demonstrated the best treatment outcomes.
Conclusions:
- Pediatric PNES generally has a better prognosis than adult PNES, potentially due to more external and identifiable causes amenable to intervention.
- Comprehensive assessment, clear communication, and integrated treatment plans addressing both symptoms and underlying factors are vital for successful management of pediatric PNES.
Aim:
To determine the outcome and identify predictive factors in children with psychogenic non-epileptic seizures (PNES).
Method:
The biographies of 35 children with PNES, attending a tertiary paediatric neurology centre, were reviewed.
Results:
Thirty five children attending the department between 1987 and 1997 were evaluated at a mean follow up of 4.6 years. The age range was 6-18 years. Twenty four were girls and 11 were boys. Eleven patients had a diagnosis of epilepsy with PNES, the remainder having PNES alone. Cause fell into four categories: a history of violence, abuse, or neglect; a high level of anxiety; dysfunctional family relationships; and attention seeking or avoidance behaviour. Management in all but five cases involved assessment and follow up by a child psychologist or child psychiatrist. The outcome was encouraging, with 66% of patients becoming PNES free. A further 23% have > 50% reduction in the frequency of PNES. Only two have had no reduction. Outcome was best in the group without epilepsy.
Conclusion:
These results suggest that the prognosis of PNES is better in children than in adults, perhaps because causes are more likely to be external to the child, more easily identified, and more amenable to prompt intervention. The importance of good assessment, good communication, and a treatment plan that includes both symptom management and addressing the precipitating and perpetuating factors is emphasised.