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Psychogenic Nonepileptic Seizures in Children and Adolescents
Hema Patel1, Hillary Blake2, David Dunn3
1Department of Neurology, Section of Pediatric Neurology, Children's Wisconsin, Medical College of Wisconsin, USA. Correspondence to: Dr Hema Patel, Professor, Clinical Neurology, Department of Pediatric Neurology, 999, North 92nd Street, Suite 540, Milwaukee, WI 53226, USA. hpatel@mcw.edu.
Insights
Psychogenic non-epileptic seizures (PNES) in children and adolescents are common, but research on their development is limited. Pediatric PNES may have better outcomes than adult cases, but more studies are needed.
Area of Science:
- Neurology
- Pediatric Neurology
- Child Psychiatry
Background:
- Psychogenic non-epileptic seizures (PNES) are frequently encountered in pediatric epilepsy evaluations.
- Limited literature exists on developmental changes and specific characteristics of PNES in children and adolescents.
Purpose of the Study:
- To review the existing literature on psychogenic non-epileptic seizures (PNES) in pediatric populations.
- To summarize clinical features, predisposing factors, workup, and outcomes of PNES in children and adolescents.
Main Methods:
- A comprehensive literature search was conducted on PubMed using terms related to PNES and non-epileptic seizures.
- Filters included human subjects, ages 1-18 years, English language, and publication dates from 2004-2019.
- A total of 54 articles were reviewed, including those identified through cross-referencing.
Main Results:
- Most studies on pediatric PNES were retrospective.
- Clinical features, predisposing factors, and diagnostic workup for pediatric PNES were detailed.
- No consensus exists on psychiatric comorbidities, and no controlled treatment trials are available for pediatric PNES, though cognitive behavioral therapy is standard for adults.
Conclusions:
- Pediatric PNES appear to have better outcomes compared to adult cases.
- There is a critical need for long-term prospective studies to better understand the clinical features, outcomes, and comorbid conditions associated with pediatric and adolescent PNES.
Context:
Though psychogenic non-epileptic seizures (PNES) are seen commonly during evaluation of children and adolescents with epilepsy, the literature regarding developmental changes in PNES is limited.
Evidence Acquisition:
Literature search was conducted in PubMed. Key search terms included: Pseudoseizure* OR PNES OR [(non-epileptic or nonepileptic or psychogenic or non-epileptic attack disorder) AND (seizure*)], resulting in 3,236 articles. Filters included human, ages 1-18 years, English language and last 15 years (2004-2019), resulting in 533 articles. We reviewed 33 articles, which included 19 articles that involved children (1-18 years), with 10 or more children with PNES in their study group. 21 articles obtained in cross references that were outside the filter setting (including time frame and age range) were also reviewed, for a total of 54 articles.
Results:
Majority of the studies were retrospective. We detail clinical features, predisposing factors and appropriate workup for children and adolescents with possible PNES. There is no consensus regarding frequency of psychiatric comorbidities in children with PNES. No controlled trials of treatment of PNES in children are available, but cognitive behavioral therapy is the consensus for adult PNES. Outcome appears to be better in children with PNES.
Conclusion:
There is a need for be long-term prospective studies to document various clinical features and outcome of pediatric and adolescent PNES, and also the comorbid conditions.
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