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Does the teddy bear sign predict psychogenic nonepileptic seizures?
Mackenzie C Cervenka1, Ronald Lesser, Tung T Tran
1Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA. mcerven1@jhmi.edu
Epilepsy & Behavior : E&B
|June 18, 2013
Summary
The "teddy bear sign," or bringing stuffed animals to an epilepsy monitoring unit (EMU), does not reliably indicate psychogenic nonepileptic seizures (PNES). This study found no significant link between stuffed animals and PNES diagnosis in most patients.
Area of Science:
- Neurology
- Psychiatry
- Clinical Medicine
Background:
- Psychogenic nonepileptic seizures (PNES) are often misdiagnosed as epilepsy.
- The
- teddy bear sign
- (possession of stuffed animals in the epilepsy monitoring unit) has been anecdotally associated with PNES.
Purpose of the Study:
- To investigate the association between the
- teddy bear sign
- and a diagnosis of PNES versus epilepsy.
- To determine if this sign is a reliable indicator for PNES.
Main Methods:
- Prospective evaluation of 335 patients aged 15 and older admitted to an epilepsy monitoring unit (EMU) over 19 months.
- Data collected included age, seizure onset, duration, gender, diagnosis, intellectual disabilities, psychiatric illness, and possession of a stuffed animal.
- Statistical analysis was performed to assess the relationship between the
- teddy bear sign
- and seizure diagnosis.
Main Results:
- Overall, patients bringing stuffed animals were not more likely to have PNES than epilepsy.
- In patients aged 18 and older, a statistically significant association was found after adjusting for other factors, but the absolute differences were small.
- Patients 18+ with stuffed animals had 3.21 times greater odds of PNES or combined PNES/epilepsy diagnosis after adjustments (p=0.022).
Conclusions:
- The presence of a stuffed animal in the EMU (the
- teddy bear sign
- ) is not a reliable diagnostic indicator for psychogenic nonepileptic seizures (PNES).
- Clinical judgment and comprehensive diagnostic evaluation remain crucial for accurate seizure disorder diagnosis.
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