Skip to main content

Advertisement

SpringerLink
Log in

Psychogenic Nonepileptic Seizures in Children and Adolescents

  • Review Article
  • Published:
Indian Pediatrics Aims and scope Submit manuscript

Abstract

Context

Though psychogenic non-epileptic seizures (PNES) are seen commonly during evaluation of children and adolescents with epilepsy, the literature regarding developmental changes in PNES is limited.

Evidence Acquisition

Literature search was conducted in PubMed. Key search terms included: Pseudoseizure* OR PNES OR [(non-epileptic or nonepileptic or psychogenic or non-epileptic attack disorder) AND (seizure*)], resulting in 3,236 articles. Filters included human, ages 1–18 years, English language and last 15 years (2004–2019), resulting in 533 articles. We reviewed 33 articles, which included 19 articles that involved children (1–18 years), with 10 or more children with PNES in their study group. 21 articles obtained in cross references that were outside the filter setting (including time frame and age range) were also reviewed, for a total of 54 articles.

Results

Majority of the studies were retrospective. We detail clinical features, predisposing factors and appropriate workup for children and adolescents with possible PNES. There is no consensus regarding frequency of psychiatric comorbidities in children with PNES. No controlled trials of treatment of PNES in children are available, but cognitive behavioral therapy is the consensus for adult PNES. Outcome appears to be better in children with PNES.

Conclusions

There is a need for be long-term prospective studies to document various clinical features and outcome of pediatric and adolescent PNES, and also the comorbid conditions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Patel H, Scott E, Dunn D, Garg B. Nonepileptic seizures in children. Epilepsia. 2007;48:2086–92.

    Article  PubMed  Google Scholar 

  2. Szabo L, Siegler Z, Zubek L, et al. A detailed semiologic analysis of childhood psychogenic nonepileptic seizures. Epilepsia. 2012;53:565–70.

    Article  PubMed  Google Scholar 

  3. Lesser R. Psychogenic seizures. Neurology. 1996;46:1499–507.

    Article  CAS  PubMed  Google Scholar 

  4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.

  5. The ICD-10 Classification of Mental and Behavioral disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organization:1992.

  6. Gates JR. Epidemiology and classification of non-epileptic events. In: Gates JR, Rowan AJ, editors. Non-epileptic seizures. 2nd ed. Butterworth-Heinemann; 2011.p.3–14.

  7. Benbadis SR, Allen Hauser W. An estimate of the prevalence of psychogenic non-epileptic seizures. Seizure. 2000;9:280–81.

    Article  CAS  PubMed  Google Scholar 

  8. Reuber M. Psychogenic nonepileptic seizures: answers and questions. Epilepsy Behav. 2008;12:622–35.

    Article  PubMed  Google Scholar 

  9. Holmes GL, Sackellares JC, McKiernan J, Ragland M, Dreifuss FE. Evaluation of childhood pseudoseizures using EEG telemetry and video tape monitoring. J Pediatr. 1980;97:554–58.

    Article  CAS  PubMed  Google Scholar 

  10. Kutluay E, Selwa L, Minecan D, Edwards J, Beydoun A. Nonepileptic paroxysmal events in a pediatric population. Epilepsy Behav. 2010;17:272–75.

    Article  PubMed  Google Scholar 

  11. Kim SH, Kim H, Lim BC, et al. Paroxysmal nonepileptic events in pediatric patients confirmed by long-term video-EEG monitoring—Single tertiary center review of 143 patients. Epilepsy Behav. 2012;24:336–40.

    Article  PubMed  Google Scholar 

  12. Bhatia MS, Sapra S. Pseudoseizures in children: A profile of 50 cases. Clin Pediatr (Phila). 2005;44:617–21.

    Article  Google Scholar 

  13. Dhiman V, Sinha S, Rawat VS, et al. Children with psychogenic non-epileptic seizures (PNES): a detailed semiologic analysis and modified new classification. Brain Dev. 2014;36:287–93.

    Article  PubMed  Google Scholar 

  14. Madaan P, Gulati S, Chakrabarty B, et al. Clinical spectrum of psychogenic non epileptic seizures in children: An observational study. Seizure. 2018;59:60–66.

    Article  PubMed  Google Scholar 

  15. Vincentiis S, Valente KD, Thome-Souza S, Kuczinsky E, Fiore LA, Negrao N. Risk factors for psychogenic nonepileptic seizures in children and adolescents with epilepsy. Epilepsy Behav. 2006;8:294–98.

    Article  PubMed  Google Scholar 

  16. Valente KD, Alessi R, Vincentiis S, Santos BD, Rzezak P. risk factors for diagnostic delay in psychogenic nonepileptic seizures among children and adolescents. Pediatr Neurol. 2017;67:71–77.

    Article  PubMed  Google Scholar 

  17. Goldstein LH, Robinson EJ, Reuber M, et al. Characteristics of 698 patients with dissociative seizures: A UK multicenter study. Epilepsia. 2019;60:2182–93.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Davis BJ. Predicting nonepileptic seizures utilizing seizure frequency, EEG, and response to medication. Eur Neurol. 2004;51:153–56.

    Article  PubMed  Google Scholar 

  19. LaFrance WC, Jr., Reuber M, Goldstein LH. Management of psychogenic nonepileptic seizures. Epilepsia. 2013;54:53–67.

    Article  PubMed  Google Scholar 

  20. Plioplys S, Doss J, Siddarth P, et al. A multisite controlled study of risk factors in pediatric psychogenic nonepileptic seizures. Epilepsia. 2014;55:1739–47.

    Article  PubMed  Google Scholar 

  21. Wyllie E, Glazer JP, Benbadis S, Kotagal P, Wolgamuth B. Psychiatric features of children and adolescents with pseudoseizures. Arch Pediatr Adolesc Med. 1999;153:244–48.

    Article  CAS  PubMed  Google Scholar 

  22. Say GN, Tasdemir HA, Ince H. Semiological and psychiatric characteristics of children with psychogenic nonepileptic seizures: Gender-related differences. Seizure. 2015;31:144–48.

    Article  PubMed  Google Scholar 

  23. Verrotti A, Agostinelli S, Mohn A, et al. Clinical features of psychogenic non-epileptic seizures in prepubertal and pubertal patients with idiopathic epilepsy. Neurol Sci. 2009;30:319–23.

    Article  PubMed  Google Scholar 

  24. Plioplys S, Doss J, Siddarth P, et al. Risk factors for comorbid psychopathology in youth with psychogenic nonepileptic seizures. Seizure. 2016;38:32–37.

    Article  PubMed  Google Scholar 

  25. Asadi-Pooya AA, Al Baradie R, Sawchuk T, Bahrami Z, Al Amer A, Buchhalter J. Psychogenic nonepileptic seizures in children and adolescents: An international cross-cultural study. Epilepsy Behav. 2019;90:90–92.

    Article  PubMed  Google Scholar 

  26. Reuber M, Brown RJ. Understanding psychogenic nonepileptic seizures-phenomenology, semiology and the Integrated Cognitive Model. Seizure. 2017;44:199–205.

    Article  PubMed  Google Scholar 

  27. Vasta R, Cerasa A, Sarica A, et al. The application of artificial intelligence to understand the pathophysiological basis of psychogenic nonepileptic seizures. Epilepsy Behav. 2018;87:167–172.

    Article  PubMed  Google Scholar 

  28. Fogarasi A, Janszky J, Tuxhorn I. Ictal emotional expressions of children with partial epilepsy. Epilepsia. 2007;48:120–23.

    PubMed  Google Scholar 

  29. Alessi R, Vincentiis S, Rzezak P, Valente KD. Semiology of psychogenic nonepileptic seizures: Age-related differences. Epilepsy Behav. 2013;27:292–95.

    Article  PubMed  Google Scholar 

  30. Chung SS, Gerber P, Kirlin KA. Ictal eye closure is a reliable indicator for psychogenic nonepileptic seizures. Neurology. 2006;66:1730–31.

    Article  PubMed  Google Scholar 

  31. Burneo JG, Martin R, Powell T, et al. Teddy bears: An observational finding in patients with non-epileptic events. Neurology. 2003;61:714–15.

    Article  CAS  PubMed  Google Scholar 

  32. Vossler DG, Haltiner AM, Schepp SK, et al. Ictal stuttering: A sign suggestive of psychogenic nonepileptic seizures. Neurology. 2004;63:516–19.

    Article  CAS  PubMed  Google Scholar 

  33. Chabolla DR, Shih JJ. Postictal behaviors associated with psychogenic nonepileptic seizures. Epilepsy Behav. 2006;9:307–11.

    Article  PubMed  Google Scholar 

  34. Kramer U, Carmant L, Riviello JJ, et al. Psychogenic seizures: Video telemetry observations in 27 patients. Pediatr Neurol. 1995;12:39–41.

    Article  CAS  PubMed  Google Scholar 

  35. Benbadis SR, Johnson K, Anthony K, et al. Induction of psychogenic nonepileptic seizures without placebo. Neurology. 2000;55:1904–05.

    Article  CAS  PubMed  Google Scholar 

  36. Benbadis SR, Siegrist K, Tatum WO, Heriaud L, Anthony K. Short-term outpatient EEG video with induction in the diagnosis of psychogenic seizures. Neurology. 2004;63:1728–30.

    Article  CAS  PubMed  Google Scholar 

  37. Reilly C, Menlove L, Fenton V, Das KB. Psychogenic nonepileptic seizures in children: A review. Epilepsia. 2013;54:1715–24.

    Article  PubMed  Google Scholar 

  38. Chen DK, So YT, Fisher RS. Use of Serum Prolactin In Diagnosing Epileptic Seizures: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2005; 65: 668–75.

    Article  CAS  PubMed  Google Scholar 

  39. Dogan EA, Unal A, Unal A, Erdogan C. Clinical utility of serum lactate levels for differential diagnosis of generalized tonic-clonic seizures from psychogenic nonepileptic seizures and syncope. Epilepsy Behav. 2017;75:13–17.

    Article  PubMed  Google Scholar 

  40. Wyllie E, Lueders H, Pippenger C, VanLente F. Postictal serum creatine kinase in the diagnosis of seizure disorders. Arch Neurol. 1985;42:123–26.

    Article  CAS  PubMed  Google Scholar 

  41. Ceylan M, Yalcin A, Bayraktutan OF, Laloglu E. Serum NT-pro CNP levels in epileptic seizure, psychogenic non-epileptic seizure, and healthy subjects. Neurol Sci. 2018;39:2135–39.

    Article  PubMed  Google Scholar 

  42. Goodman R, Ford T, Richards H, Gatward R, Meltzer H. The development and well-being assessment: Description and initial validation of an integrated assessment of child and adolescent psychopathology. J Child Psychol Psychiatry. 2000;41:645–55.

    Article  CAS  PubMed  Google Scholar 

  43. Plioplys S, Asato MR, Bursch B, Salpekar JA, Shaw R, Caplan R. Multidisciplinary management of pediatric nonepileptic seizures. J Am Acad Child Adolesc Psychiatry. 2007;46:1491–95.

    Article  PubMed  Google Scholar 

  44. McFarlane FA, Allcott-Watson H, Hadji-Michael M, et al. Cognitive-behavioral treatment of functional neurological symptoms (conversion disorder) in children and adolescents: A case series. Eur J Paediatr Neurol. 2019;23:317–28.

    Article  PubMed  Google Scholar 

  45. Sawchuk T, Buchhalter J, Senft B. Psychogenic nonepileptic seizures in children-prospective validation of a clinical care pathway and risk factors for treatment outcome. Epilepsy Behav. 2020;105:106971.

    Article  PubMed  Google Scholar 

  46. LaFrance WC Jr, Baird GL, Barry JJ, et al. Multicenter pilot treatment trial for psychogenic nonepileptic seizures: a randomized clinical trial. JAMA Psychiatry. 2014;71:997–1005.

    Article  PubMed  Google Scholar 

  47. Goldstein LH, Robinson EJ, Mellers JDC, et al. Cognitive behavioral therapy for adults with dissociative seizures (CODES): A pragmatic, multicenter, randomized, controlled trial. Lancet Psychiatry. 2020;7:491–505.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Wyllie E, Friedman D, Luders H, Morris H, Rothner D, Turnbull J. Outcome of psychogenic seizures in children and adolescents compared with adults. Neurology. 1991;41:742–44.

    Article  CAS  PubMed  Google Scholar 

  49. Chinta SS, Malhi P, Singhi P, Prabhakar S. Clinical and psychosocial characteristics of children with nonepileptic seizures. Ann Indian Acad Neurol. 2008;11:159–63.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Yadav A, Agarwal R, Park J. Outcome of psychogenic nonepileptic seizures (PNES) in children: A 2-year follow-up study. Epilepsy Behav. 2015;53:168–73.

    Article  PubMed  Google Scholar 

  51. Yilmaz U, Serdaroglu A, Gurkas E, Hirfanoglu T, Cansu A. Childhood paroxysmal nonepileptic events. Epilepsy Behav. 2013;27:124–49.

    Article  PubMed  Google Scholar 

  52. Salpekar JA, Plioplys S, Siddarth P, et al. Pediatric psychogenic nonepileptic seizures: a study of assessment tools. Epilepsy Behav. 2010;17:50–55.

    Article  PubMed  Google Scholar 

  53. Kacinski M, Leskiewicz M, Jaworska-Feil L, et al. Pseudo-epileptic seizures in children are not associated with enhanced plasma level of allopregnanolone. Pharmacol Rep. 2007;59:683–90.

    CAS  PubMed  Google Scholar 

  54. Uldall P, Alving J, Hansen LK, Kibaek M, Buchholt J. The misdiagnosis of epilepsy in children admitted to a tertiary epilepsy center with paroxysmal events. Arch Dis Child. 2006;91:219–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. From Department of Neurology, Section of Pediatric Neurology, Children’s Wisconsin, Medical College of Wisconsin, Wauwatosa, USA

    Hema Patel

  2. From Department of Clinical Psychiatry, Section of Child Psychology, Indiana University School of Medicine, Indianapolis, USA

    Hillary Blake

  3. From Department of Psychiatry and Neurology, Riley Hospital for Children, Indiana University Medical Center, Indianapolis, USA

    David Dunn

  4. Department of Pediatric Neurology, Clinical Neurology, 999, North 92nd Street, Suite 540, Milwaukee, WI, 53226, USA

    Hema Patel

Authors
  1. Hema Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hillary Blake
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Dunn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hema Patel.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Patel, H., Blake, H. & Dunn, D. Psychogenic Nonepileptic Seizures in Children and Adolescents. Indian Pediatr 58, 259–265 (2021). https://doi.org/10.1007/s13312-021-2167-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13312-021-2167-9

Keywords

Search

Navigation