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Paroxysmal Nonepileptic Events in Children With Epilepsy and Cerebral Palsy
Monica S Cooper1,2,3, Michael C Fahey4, Charuta Dagia5
1Department of Neurodevelopment & Disability, Royal Children's Hospital, Melbourne, Parkville, Victoria, Australia.
Insights
Paroxysmal nonepileptic events are common in children with cerebral palsy and epilepsy. Clearer counseling is needed to help parents distinguish these events from epileptic seizures, improving diagnosis and care.
Area of Science:
- Neurology
- Pediatrics
- Epileptology
Background:
- Cerebral palsy (CP) is a common neurodevelopmental disorder.
- Epilepsy frequently co-occurs with CP, often stemming from brain injury.
- Differentiating epileptic from nonepileptic events in this population is clinically challenging.
Purpose of the Study:
- To ascertain the incidence of paroxysmal nonepileptic events (PNEs) in children with CP and epilepsy.
- To identify factors associated with PNEs in this cohort.
- To assess the accuracy of parental/carer event reporting.
Main Methods:
- Retrospective, population-based cohort study utilizing the Victorian CP Register (birth years 1999-2006).
- Analysis of neuroimaging, medical records, and electroencephalograms (EEGs) with video correlation.
- Inclusion criteria: children with CP due to brain injury and diagnosed epilepsy.
Main Results:
- Of 256 children with CP, 87 had epilepsy; 82 had analyzable EEGs.
- Epileptic events were captured on EEG in 22% (18/82) of children.
- Paroxysmal nonepileptic events were captured on EEG in 26% (21/82) of children.
- 77% (13/18) of children with epileptic events also had PNEs.
- Parental/carer reporting misattributed PNEs as epileptic in 10 cases.
Conclusions:
- Approximately one-fourth of children with CP and epilepsy in this cohort exhibited PNEs on EEG.
- A significant proportion of reported nonepileptic events were misclassified by caregivers.
- Enhanced patient and caregiver education on seizure semiology is crucial for accurate diagnosis in children with CP and epilepsy.
Abstract:
Objective: To determine the frequency of paroxysmal nonepileptic events in children with cerebral palsy due to brain injury who have epilepsy and to describe the factors associated with paroxysmal nonepileptic events. Methods: Retrospective, population-based study of children from the Victorian CP Register born 1999-2006. Neuroimaging, medical records, electroencephalograms (EEG), and EEG requests were analyzed. Results: Of the included 256 children, 87 had epilepsy. EEGs (with video correlation) were available for 82 of 87. Eighteen (18/82, 22%) had epileptic events captured on EEG. Twenty-one (21/82, 26%) had paroxysmal nonepileptic events captured on EEG. The majority (13/18, 77%) of children with epileptic events also had paroxysmal nonepileptic events captured. Ten parents and carers continued to report events as epileptic despite there being no ictal EEG correlate for specific events on multiple EEGs. There were no clear associations to identify which children would have ongoing paroxysmal nonepileptic events reported. Conclusions: Paroxysmal nonepileptic events were captured on EEG in one-fourth of children from this cerebral palsy cohort with epilepsy and available EEG. Half the parents and carers reported previously identified paroxysmal nonepileptic events as epileptic on subsequent EEGs, highlighting the need for clearer counseling so that parents better understand seizure semiology in children with EEG-proven paroxysmal nonepileptic events.
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