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Evaluation of childhood pseudoseizures using EEG telemetry and video tape monitoring
Insights
Pseudoseizures, events mimicking epileptic seizures, are common in children with difficult-to-treat epilepsy. Differentiating them requires careful clinical observation, as they often coexist with true epileptic seizures.
Area of Science:
- Neurology
- Pediatric Neurology
- Epileptology
Background:
- Pseudoseizures are clinical events that resemble epileptic seizures but lack central nervous system paroxysmal activity.
- Differentiating pseudoseizures from epileptic seizures can be challenging in clinical practice.
- Intractable seizures in children necessitate accurate diagnosis for effective management.
Purpose of the Study:
- To determine the frequency of pseudoseizures in pediatric patients with intractable seizures.
- To describe the clinical manifestations of pseudoseizures in this population.
- To identify clinical features that aid in distinguishing pseudoseizures from epileptic seizures.
Main Methods:
- Prospective study involving children admitted to a Comprehensive Epilepsy Unit.
- Utilized prolonged simultaneous electroencephalography (EEG) telemetry and video recording (VTR).
- Compared clinical characteristics of pseudoseizures and documented epileptic seizures.
Main Results:
- Pseudoseizures were identified in 11 out of 53 pediatric patients (20.8%).
- Eight of the 11 patients with pseudoseizures also had confirmed epileptic seizures.
- Postictal state duration, incontinence, combativeness, stress association, and medication response were key differentiating factors.
Conclusions:
- Pseudoseizures are relatively common in pediatric patients with intractable epilepsy.
- Pseudoseizures frequently occur alongside epileptic seizures, complicating diagnosis.
- Careful clinical observation and specific criteria can aid in differentiating pseudoseizures from epileptic seizures.
Abstract:
Pseudoseizures, clinical events that superficially resemble epileptic attacks but which are not associated with central nervous system paroxysmal activity, are often difficult to differentiate from epileptic seizures. To evaluate the frequency and clinical manifestations of pseudoseizures in children with intractable seizures, children admitted to a Comprehensive Epilepsy Unit received prolonged simultaneous EEG telemetry and video recording. Pseudoseizures occurred in 11 of 53 pediatric patients admitted during the study period. Eight of the 11 patients with pseudoseizures also had documented epileptic seizures. Clinical characteristics of pseudoseizures and epileptic seizures documented by TEEG-VR were compared. Degree and duration of the postictal state, incontinence, combativeness, relationship to stress, and response to anticonvulsant medication were useful differentiating criteria. Pseudoseizures are not unusual in pediatric patients, often occur concurrently with epileptic seizures, and may be difficult to diagnose. However, careful clinical observation may offer clues in differentiating pseudoseizures from epileptic seizures.