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Pediatric functional seizures: Demographics, clinical and psychological characteristics and risk factors
Sherifa Ahmed Hamed1, Ali Farrag ElHadad2, Mohamed Fawzy1
1Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt.
Insights
Pediatric functional seizures (FS), also known as psychogenic non-epileptic seizures (PNES), are common in epilepsy clinics, affecting approximately 15% of patients. Early diagnosis and management of FS are crucial to prevent long-term developmental issues.
Area of Science:
- Neurology
- Pediatrics
- Psychiatry
Background:
- Pediatric functional seizures (FS), or psychogenic non-epileptic seizures (PNES), are understudied compared to adult populations.
- Understanding the prevalence, clinical characteristics, and predictors of pediatric FS is essential for improving patient outcomes.
Purpose of the Study:
- To determine the prevalence of FS in pediatric epilepsy clinics.
- To investigate the clinical patterns, behavioral characteristics, and risk predictors associated with pediatric FS.
Main Methods:
- Patients were recruited from outpatient pediatric epilepsy clinics.
- Data included demographics, clinical features, video-electroencephalography, psychiatric interviews, and psychometric questionnaires (Child Behavior Check List).
Main Results:
- FS prevalence was 15.42% in pediatric epilepsy clinics; 5.14% had mixed epilepsy and FS.
- FS predominantly affected adolescents (66.7%) with a mean age of 14 years, and diagnosis delay ranged from 4-14 months.
- Patients with FS exhibited higher scores on the Child Behavior Check List (anxiety, somatization, inattention) and internalizing/externalizing behavior problems compared to controls and epilepsy patients.
Conclusions:
- Functional seizures are a frequent diagnosis in pediatric epilepsy clinics, often misdiagnosed as epilepsy.
- Psychosocial factors such as self-efficacy conflicts and school/family problems are significant predictors of FS.
- Timely diagnosis and management of pediatric FS are critical to mitigate negative impacts on personality, social interactions, and academic performance.
Abstract:
The prevalence, semiology, comorbidities and predictors of pediatric functional seizures (FS) [also known as psychogenic non-epileptic seizures (PNES)] are greatly understudied compared to adults. We aimed to determine the prevalence in the epilepsy clinics, clinical patterns, behavioral characteristics and risk predictors for pediatric FS. Patients were recruited from the outpatient pediatric epilepsy clinics of tertiary referral hospitals. During the study, the total number of attended patients and diagnosed as epilepsy was 350. Data collection included demographics, clinical features, video records for seizure-like concerns and electroencephalography records. The prevalence of FS was 15.42 % (54/350; boy = 24, girl = 30), among were 5.14 % (18/350) had mixed epilepsy and FS. Detailed behavioral assessment was done for a total of 210 (boys = 84; girls = 126), among were 156 had epilepsy, 36 (boys = 9; girls = 27) with FS and 18 (boys = 15; girls = 3) had mixed epilepsy and FS. This included psychiatric interviewing and application of psychometric questionnaires including Child Behavior Check List (CBCL6/18) and psychosocial risks. Patients with FS were predominantly adolescents (66.7 % or 36/54) with mean age of ∼ 14 years. The delay in diagnosis of FS was 4-14 months. FS semiology included motor (n = 36) and unresponsiveness (n = 18) attacks. Compared to controls and patients with epilepsy, those with FS had higher Total Scores of CBCL and its subsets (anxiety, somatization and inattention) and scores of Internalizing (P = 0.0001; P = 0.015) and Externalizing (P = 0.0001; P = 0.027) Behavior Problems. The psychosocial predictors with FS included self-efficacy conflicts and school and family problems. To conclude, FS are frequent conditions in pediatric epilepsy clinics (∼15 %) and are misdiagnosed and mistreated as epilepsy. Their early diagnosis and management are critical to prevent problems in personality and social and school activities.
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