Semiological differences of functional seizures between pediatrics and adults: video electroencephalography analysis

Diagnosing functional seizures can be challenging, and the semiology may vary between pediatric and adult age groups. Identifying those variabilities may be of diagnostic value. This study aimed to compare the semiological characteristics of functional seizures in both the pediatric and adult populations.

All video ictal electroencephalogram (EEG) recordings at Cairo University Epilepsy Unit (CUEU) from January 2021 to December 2023 were retrospectively reviewed for adults or children with functional seizures. Detailed semiological characteristics of the ictal events were analyzed independently by at least two epileptologists. Each event was listed under the classification system as either major motor, minor motor, dialeptic, non-epileptic aura, or mixed type.

A total of 54 pediatric and 65 adult video ictal EEG studies were evaluated. Minor motor type was the most common clinical semiology among adult and pediatric groups, yet more prevalent in pediatric than adult patients (61.1% vs. 40.0%, P = 0.022). In comparison, the major motor events were significantly higher in adults than in pediatrics (25 event [38.5%] vs. 9 events [16.7%], P = 0.009). No statistically significant differences were found between pediatrics and adults regarding pelvic thrusting (3.7% vs. 9.2%), back arching (7.4% vs. 4.6%), clenched fists (9.3% vs. 15.4%), ictal pain (13.0% vs. 18.5%), ictal fear (5.6% vs. 3.1%), or ictal crying (7.4% vs. 4.6%), respectively.

The semiology of functional seizures varies between pediatric and adult age groups; minor motor events predominate in pediatric patients, while the major motor type is more common in adults.