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Outcome of pseudoseizures in children and adolescents: a 6-year symptom survival analysis
O Gudmundsson1, M Prendergast, D Foreman
1The Children's Hospital, Birmingham, UK.
Insights
Children and adolescents with pseudoseizures without epilepsy showed good outcomes with psychiatric treatment. Prompt identification and treatment are crucial for recovery and improved prognosis.
Area of Science:
- Child and Adolescent Psychiatry
- Neurology
- Psychosomatic Medicine
Background:
- Pseudoseizures, also known as psychogenic non-epileptic seizures (PNES), are a functional neurological disorder.
- These seizures occur without epilepsy and require specialized psychiatric care.
- Understanding treatment outcomes is vital for improving patient management.
Purpose of the Study:
- To evaluate the treatment outcomes of children and adolescents with pseudoseizures without epilepsy.
- To identify factors associated with successful recovery and prognosis.
- To determine the effectiveness of inpatient and/or day patient treatment.
Main Methods:
- Retrospective case-note review of 17 patients treated between 1988 and 1994.
- Kaplan-Meier survival analysis to assess recovery rates.
- Definition of 'cure' as six months seizure freedom.
Main Results:
- Fourteen out of 17 patients recovered, resuming regular school attendance.
- Mean symptom survival time post-treatment was 1.5 years, indicating a treatment effect.
- Younger age at presentation, female sex, diverse seizure types, and combined inpatient/outpatient treatment correlated with better outcomes.
Conclusions:
- Psychiatric treatment can lead to significant recovery in children and adolescents with pseudoseizures.
- Early intervention is critical, as prognosis deteriorates with age at treatment.
- Multimodal treatment approaches (inpatient and outpatient) appear most effective.
Abstract:
Outcome was studied of all children and adolescents with pseudoseizures without epilepsy, who were referred and treated as in-patients and/or day patients in the tertiary psychiatric ward at Birmingham Children's Hospital, UK between 1988 and 1994. Information was derived from case-note data. Freedom from seizures for six months was defined as 'cure', as no recurrences after this period were noted. Kaplan-Meier survival analysis was used. Seventeen patients were identified: 15 females and two males; mean age at presentation to the tertiary psychiatric service was 12 years 9 months (SD 26 months; range 8 years 3 months to 15 years 9 months). Fourteen participants recovered and resumed regular school attendance. Three were lost to follow-up due to being referred on to other agencies before recovery because they became too old for the service. Recovery followed an exponential distribution, with a mean symptom survival time following treatment of 1.5 years. These results are consistent with a treatment effect. Younger age at presentation, female sex, having more types of seizures, and not receiving both in-patient and outpatient treatment were associated with better outcome. The deteriorating prognosis with age at treatment suggests prompt identification may be important in ensuring a good outcome.
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