Pitfalls in diagnosing psychogenic nonepileptic seizures in a sexually abused child

A six-year-old girl living in a residential care facility because of previous sexual abuse at home showed intractable seizures with epileptic discharges on interictal EEG. The features of the attacks were sudden impaired consciousness, only in daytime while eating, studying, and walking, with no motor acts and continuing for several minutes to one hour. She could not recall the attacks, and anticonvulsants showed no effects. She gradually became irritated and antisocial, exhibiting impulsive and hyperactive behavior. Interictal EEG repeatedly showed diffuse irregular spikes and wave complexes. The attacks continued sporadically for more than two years and ceased after disclosure of repeated sexual abuse by a boy at the residential care facility. In this case, delayed diagnosis of psychogenic nonepileptic seizures was associated with diagnostic difficulty of dissociative symptoms in a child, the presence of epileptiform EEG in an abused child, and undetected sexual abuse in a residential care facility, the potential for which pediatric neurologists should be aware. These pitfalls are discussed in the context of previous related literature.