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Paroxysmal Nonepileptic Events in a Pediatric Epilepsy Clinic
Ashfak H Mandli1, Neelu A Desai2, Rahul S Badheka2
1Department of Paediatrics, PD Hinduja Hospital, Mumbai, Maharashtra, India.
Insights
Paroxysmal nonepileptic events (PNEs) are common in children misdiagnosed with epilepsy. Accurate diagnosis of PNEs significantly alters treatment, reducing unnecessary anti-epileptic drug use and improving patient outcomes.
Area of Science:
- Pediatric Neurology
- Clinical Neurophysiology
Background:
- Paroxysmal events in children are often misdiagnosed as epilepsy.
- Accurate diagnosis is crucial for appropriate management and to avoid unnecessary treatments.
Purpose of the Study:
- To determine the frequency, age, and gender distribution of paroxysmal nonepileptic events (PNEs) in children referred for epilepsy.
- To evaluate the therapeutic implications of accurate diagnosis and the co-occurrence of true epilepsy.
Main Methods:
- Prospective evaluation of new pediatric patients (<18 years) presenting with paroxysmal events at a pediatric epilepsy clinic.
- Assessment included event descriptions, recorded videos, and further investigations if needed.
- Statistical analysis used Chi-square/Fisher's exact test and Kruskal-Wallis test.
Main Results:
- 19% of 200 enrolled children had PNEs; 80% had epileptic events.
- Physiological PNEs were common in younger children (<5 years), psychogenic in older children.
- Accurate diagnosis led to a significant change in treatment, with only 2.6% requiring anti-epileptic drugs for coexisting epilepsy.
Conclusions:
- Epilepsy mimics, such as PNEs, are frequent in pediatric epilepsy clinics.
- Misdiagnosis of PNEs can lead to undue stress and inappropriate treatment with anti-epileptic drugs.
- Correct diagnosis facilitates optimized management, including drug withdrawal or initiation of specific treatments.
Aims:
We aimed to study the frequency, age, and gender distribution of paroxysmal nonepileptic events (PNEs) in children referred to epilepsy clinic with the diagnosis of epilepsy. We also evaluated the therapeutic implications of correct diagnosis and co-existence of true epilepsy in this population.
Settings And Design:
All new patients below 18 years attending the Pediatric epilepsy out-patient clinic of PD Hinduja hospital over 6 months were evaluated.
Materials And Methods:
Patients with history of paroxysmal events characterized by abrupt changes in consciousness or behavior or movement were included. They were assessed on description of events aided by recorded videos. If the diagnosis was not confirmed by this preliminary evaluation, further investigations were advised.
Statistical Analysis Used:
Chi-square/Fisher's exact test was used to analyze differences between categorical variables and Kruskal-Wallis test between continuous variables. The data were analyzed by SAS University Edition. All significance tests were two-tailed with α <0.05.
Results:
Two hundred new patients presenting with paroxysmal events were enrolled over 6 months. After diagnoses, 19% of these children had PNEs, 80% had epileptic events, and 1% remained undiagnosed. Common nonepileptic events seen were physiological in patients below 5 years and psychogenic in older children. Thirty-four percent of patients with PNEs were on anti-epileptic drugs (AEDs). After confirming nonepileptic attacks, only 2.6% patients needed AEDs for coexisting epilepsy which was statistically significant (P < 0.001) change in treatment.
Conclusions:
Epilepsy mimics are common in children and are often misdiagnosed causing undue stress. Correct diagnosis leads to a drastic change in management like withdrawal of drugs, commencing new treatment if needed, and appropriate referrals.
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