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Psychiatric and personality factors in pediatric functional seizures: A prospective case-control study
Lindsay Stager1, Skylar Morriss1, Jerzy P Szaflarski2
1University of Alabama at Birmingham, Department of Psychology, Birmingham, Alabama, USA.
Insights
Children with pediatric functional seizures (FS) experience more somatization and lower quality of life, but not increased psychiatric or personality issues. These factors do not predict FS likelihood, suggesting other causes for pediatric functional seizures.
Area of Science:
- Neurology
- Psychiatry
- Pediatrics
Background:
- Pediatric functional seizures (FS) are a significant challenge in child neurology.
- Understanding the underlying factors, including psychiatric and personality traits, is crucial for effective management.
Purpose of the Study:
- To assess psychiatric and personality characteristics in children with pediatric functional seizures (FS).
- To determine if these characteristics are associated with the likelihood of developing FS.
Main Methods:
- A 1:1 matched-control study design compared 42 children with FS to 42 matched controls (MCs).
- Utilized the Behavior Assessment System for Children (BASC-2) and Millon Adolescent Clinical Inventory (MACI) for primary outcomes.
- Assessed secondary measures including trauma, somatization, body awareness, and quality of life (QOL).
Main Results:
- Children with FS reported significantly higher somatization and poorer QOL compared to MCs.
- No significant differences were found in clinically elevated psychiatric or personality scores between groups.
- Clinically elevated scores did not predict the likelihood of participants having FS.
Conclusions:
- Pediatric functional seizures are associated with increased somatization and reduced quality of life.
- Psychiatric symptoms, trauma, and personality traits do not appear to be primary predictors of FS.
- Novel contributors beyond psychiatric etiology should be explored for pediatric FS.
Purpose:
This study assessed psychiatric and personality characteristics in relation to pediatric functional seizures (FS).
Methods:
In a 1:1 prospectively matched-control study design, children with documented FS (confirmed via video EEG; ages 13-18) were matched to controls (MCs) on income, sex, race, and age. Primary outcomes were Behavior Assessment System for Children, Second Edition (BASC-2) and Millon Adolescent Clinical Inventory (MACI). Secondary measures included questionnaires assessing trauma, somatization, body awareness and quality of life (QOL). T-tests investigated differences between groups on T-scores. Due to lack of significant outcomes, an experimental analysis was conducted assessing differences in number of clinically elevated BASC-2 and MACI scores between groups. Binary logistic regressions determined the influences of clinically elevated scores on likelihood participants have FS. T-tests assessed differences on secondary measures.
Results:
Participants included 84 children, 42 with FS and 42 MCs (Children with FS: Meanage=15.4, Interquartile Rangeage=3; 73.5% female; 59.5% white). Children with FS had greater parent-reported somatization (t(23)=5.67, p<0.001) on BASC-2, greater somatization on CSSI-24 (t(35)=6.83, p<0.001), and poorer QOL (t(41)=-6.22; p<0.001) than MCs. There were no differences in clinically elevated BASC-2 or MACI scores compared to MCs and clinically elevated scores did not influence likelihood participants have FS.
Conclusions:
Children with FS had greater somatization and poorer QOL but similar rates of psychiatric symptoms, trauma, and maladaptive personality traits compared to MCs. Psychiatric or personality factors did not predict likelihood of FS. Explanations of pediatric FS should consider novel contributors to FS rather than relying solely on a psychiatric etiology.
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