Paroxysmal nonepileptic events in pediatric patients
Eu Gene Park1, Jiwon Lee1, Bo Lyun Lee2
1Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Insights
Pediatric paroxysmal nonepileptic events (PNEs) show age-specific patterns, with physiologic symptoms in younger children and psychogenic seizures in older ones. Long-term video-EEG monitoring aids diagnosis.
Area of Science:
- Pediatric Neurology
- Clinical Neurophysiology
Background:
- Paroxysmal nonepileptic events (PNEs) are common in children, but data on their characteristics in pediatric populations, particularly without neurological disorders, are limited.
- Understanding age-specific PNE presentations is crucial for accurate diagnosis and management.
Purpose of the Study:
- To evaluate and compare the characteristics of PNEs in pediatric patients across different age groups.
- To investigate the influence of neurologic deficits on PNE types in children and adolescents.
- To enhance the early detection and diagnosis of PNEs in pediatric populations.
Main Methods:
- Retrospective review of 887 pediatric patients admitted to an epilepsy monitoring unit.
- Diagnosis of PNEs based on clinical history and long-term video-electroencephalography (VEM) monitoring.
- Patients categorized into three age groups: <6 years, 6-<12 years, and 12-<18 years.
Main Results:
- Physiologic disorders (e.g., normal infant behavior, sleep movements) were more frequent in children <6 years.
- Psychogenic nonepileptic seizures predominated in patients >6 years.
- Vasogenic syncope was common in adolescents; no significant difference in PNE types was found between patients with or without neurologic deficits.
Conclusions:
- Age-specific patterns of PNEs are evident in pediatric patients, with physiologic events in younger children and psychogenic seizures in older ones.
- Clinical pattern recognition based on age is vital for diagnosing pediatric PNEs.
- Long-term VEM is valuable for diagnosing conditions like normal infant behavior and psychogenic nonepileptic seizures in children.
Objectives:
Paroxysmal nonepileptic events (PNEs) are frequently encountered phenomena in children. Although frequencies and types of PNEs have been extensively studied in adult populations, the data available for children and adolescents are limited, especially in patients without underlying neurologic disorders. In this study, we evaluated and compared the characteristics of PNEs between age groups and according to the presence of neurologic deficits to improve early detection and diagnosis of PNEs.
Methods:
We retrospectively reviewed 887 pediatric patients who were admitted to the epilepsy monitoring unit at the Samsung Medical Center between December 2001 and July 2014. One hundred and forty-one patients (15.9%) were diagnosed as having PNEs on the basis of their clinical history and long-term video-electroencephalography (EEG) monitoring (VEM).
Results:
Children with PNEs were divided into three groups by age: 1) the infant, toddler, and preschool group (<6 years, N=50, 35.5%); 2) the school-age group (6-<12 years, N=30, 21.3%); and 3) the adolescent group (12-<18 years, N=61, 43.3%). Physiologic disorders, such as normal infant behavior, sleep movement, and staring, were more common in patients younger than 6 years of age, whereas psychogenic nonepileptic seizures were predominant in patients older than 6 years. Vasogenic syncope was also frequently observed in the adolescent group and was confirmed by the head-up tilt test. There was no significant difference in specific PNE types between the groups of patients with or without neurologic deficits.
Conclusions:
Physiologic symptoms were predominant in the younger age group, whereas psychogenic nonepileptic seizures were observed in older age groups more often. Clinical pattern recognition by age plays an important role in clinical practice, because pediatric patients present various types of PNEs with age-specific patterns. Considering various and inconsistent presentations and the importance of correct diagnosis, long-term VEM can be helpful in diagnosing normal infant behavior and psychogenic nonepileptic seizures.
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