Psychogenic Nonepileptic Seizures in Children with Epilepsy

Rajkumar Agarwal; Asim Shahid

doi:10.1055/s-0038-1676582

Journal of Pediatric Epilepsy, Table of Contents

Journal of Pediatric Epilepsy 2018; 07(03): 106-110
DOI: 10.1055/s-0038-1676582

Review Article

Georg Thieme Verlag KG Stuttgart · New York

Psychogenic Nonepileptic Seizures in Children with Epilepsy

Rajkumar Agarwal

¹Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital, Dayton, Ohio, United States

,

Asim Shahid

²Division of Pediatric Neurology, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland, Ohio, United States

› Author Affiliations

Abstract

The occurrence of psychogenic seizures in a proportion of children with epilepsy has been well described. The diagnosis of simultaneous existence of nonepileptic and epileptic seizures is often challenging as the clinical features of these conditions may overlap. However, they differ significantly in terms of the underlying pathophysiology as well as management strategies. Timely recognition can prevent harmful treatments and potentially improve patient outcome. In this article, we focus on the epidemiology, clinical features as well as management of psychogenic seizures in children with epilepsy.

Keywords

nonepileptic seizures - epilepsy - video EEG - conversion disorder

Full Text

References

References
1 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 (04) 287-293
2 Asadi-Pooya AA, Tinker J, Fletman E. Semiological classification of psychogenic nonepileptic seizures. Epilepsy Behav 2016; 64 (Pt A): 1-3
3 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington, DC: American Psychiatric Publishing; 2013
4 Reuber M, Fernández G, Bauer J, Helmstaedter C, Elger CE. Diagnostic delay in psychogenic nonepileptic seizures. Neurology 2002; 58 (03) 493-495
5 Arain AM, Song Y, Bangalore-Vittal N, Ali S, Jabeen S, Azar NJ. Long term video/EEG prevents unnecessary vagus nerve stimulator implantation in patients with psychogenic nonepileptic seizures. Epilepsy Behav 2011; 21 (04) 364-366
6 Tuxhorn IE, Fischbach HS. Pseudostatus epilepticus in childhood. Pediatr Neurol 2002; 27 (05) 407-409
7 Duncan R, Razvi S, Mulhern S. Newly presenting psychogenic nonepileptic seizures: incidence, population characteristics, and early outcome from a prospective audit of a first seizure clinic. Epilepsy Behav 2011; 20 (02) 308-311
8 Sigurdardottir KR, Olafsson E. Incidence of psychogenic seizures in adults: a population-based study in Iceland. Epilepsia 1998; 39 (07) 749-752
9 Martin R, Burneo JG, Prasad A. , et al. Frequency of epilepsy in patients with psychogenic seizures monitored by video-EEG. Neurology 2003; 61 (12) 1791-1792
10 Lesser RP. Psychogenic seizures. Neurology 1996; 46 (06) 1499-1507
11 Asadi-Pooya AA, Sperling MR. Epidemiology of psychogenic nonepileptic seizures. Epilepsy Behav 2015; 46: 60-65
12 Vincentiis S, Valente KD, Thomé-Souza S, Kuczinsky E, Fiore LA, Negrão N. Risk factors for psychogenic nonepileptic seizures in children and adolescents with epilepsy. Epilepsy Behav 2006; 8 (01) 294-298
13 Patel H, Scott E, Dunn D, Garg B. Nonepileptic seizures in children. Epilepsia 2007; 48 (11) 2086-2092
14 Benbadis SR, Agrawal V, Tatum IV WO. How many patients with psychogenic nonepileptic seizures also have epilepsy?. Neurology 2001; 57 (05) 915-917
15 Yadav A, Agarwal R, Park J. Outcome of psychogenic nonepileptic seizures (PNES) in children: a 2-year follow-up study. Epilepsy Behav 2015; 53: 168-173
16 Gordon PC, Valiengo LC, Proença IC. , et al. Comorbid epilepsy and psychogenic non-epileptic seizures: how well do patients and caregivers distinguish between the two. Seizure 2014; 23 (07) 537-541
17 Chen-Block S, Abou-Khalil BW, Arain A. , et al. Video-EEG results and clinical characteristics in patients with psychogenic nonepileptic spells: the effect of a coexistent epilepsy. Epilepsy Behav 2016; 62: 62-65
18 Morgan LA, Buchhalter J. Psychogenic paroxysmal nonepileptic events in children: a review. Pediatr Neurol 2015; 53 (01) 13-22
19 Kotagal P, Costa M, Wyllie E, Wolgamuth B. Paroxysmal nonepileptic events in children and adolescents. Pediatrics 2002; 110 (04) e46
20 Kramer U, Carmant L, Riviello JJ. , et al. Psychogenic seizures: video telemetry observations in 27 patients. Pediatr Neurol 1995; 12 (01) 39-41
21 Reuber M, Qurishi A, Bauer J. , et al. Are there physical risk factors for psychogenic non-epileptic seizures in patients with epilepsy?. Seizure 2003; 12 (08) 561-567
22 Wissel BD, Dwivedi AK, Gaston TE. , et al. Which patients with epilepsy are at risk for psychogenic nonepileptic seizures (PNES)? A multicenter case-control study. Epilepsy Behav 2016; 61: 180-184
23 Kanner AM, Balabanov A. Depression and epilepsy: how closely related are they?. Neurology 2002; 58 (08) (Suppl. 05) S27-S39
24 Alessi R, Valente KD. Psychogenic non-epileptic seizures at a tertiary care center in Brazil. Epilepsy Behav 2013; 26 (01) 91-95
25 Bowman ES. Why conversion seizures should be classified as a dissociative disorder. Psychiatr Clin North Am 2006; 29 (01) 185-211 , x
26 Moore PM, Baker GA. Non-epileptic attack disorder: a psychological perspective. Seizure 1997; 6 (06) 429-434
27 Herskovitz M. Stereotypy of psychogenic nonepileptic seizures. Epilepsy Behav 2017; 70 (Pt A): 140-144
28 Brown RJ, Reuber M. Towards an integrative theory of psychogenic non-epileptic seizures (PNES). Clin Psychol Rev 2016; 47: 55-70
29 van der Kruijs SJ, Bodde NM, Vaessen MJ. , et al. Functional connectivity of dissociation in patients with psychogenic non-epileptic seizures. J Neurol Neurosurg Psychiatry 2012; 83 (03) 239-247
30 Arthuis M, Micoulaud-Franchi JA, Bartolomei F, McGonigal A, Guedj E. Resting cortical PET metabolic changes in psychogenic non-epileptic seizures (PNES). J Neurol Neurosurg Psychiatry 2015; 86 (10) 1106-1112
31 Hernando KA, Szaflarski JP, Ver Hoef LW, Lee S, Allendorfer JB. Uncinate fasciculus connectivity in patients with psychogenic nonepileptic seizures: a preliminary diffusion tensor tractography study. Epilepsy Behav 2015; 45: 68-73
32 Magaudda A, Laganà A, Calamuneri A. , et al. Validation of a novel classification model of psychogenic nonepileptic seizures by video-EEG analysis and a machine learning approach. Epilepsy Behav 2016; 60: 197-201
33 Alessi R, Vincentiis S, Rzezak P, Valente KD. Semiology of psychogenic nonepileptic seizures: age-related differences. Epilepsy Behav 2013; 27 (02) 292-295
34 Devinsky O, Sanchez-Villaseñor F, Vazquez B, Kothari M, Alper K, Luciano D. Clinical profile of patients with epileptic and nonepileptic seizures. Neurology 1996; 46 (06) 1530-1533
35 Devinsky O, Gazzola D, LaFrance Jr WC. Differentiating between nonepileptic and epileptic seizures. Nat Rev Neurol 2011; 7 (04) 210-220
36 Avbersek A, Sisodiya S. Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures?. J Neurol Neurosurg Psychiatry 2010; 81 (07) 719-725
37 Syed TU, LaFrance Jr WC, Kahriman ES. , et al. Can semiology predict psychogenic nonepileptic seizures? A prospective study. Ann Neurol 2011; 69 (06) 997-1004
38 Chung SS, Gerber P, Kirlin KA. Ictal eye closure is a reliable indicator for psychogenic nonepileptic seizures. Neurology 2006; 66 (11) 1730-1731
39 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 (04) 319-323
40 Carreño M. Recognition of nonepileptic events. Semin Neurol 2008; 28 (03) 297-304
41 Patel H, Dunn DW, Austin JK. , et al. Psychogenic nonepileptic seizures (pseudoseizures). Pediatr Rev 2011; 32 (06) e66-e72
42 LaFrance Jr WC, Baker GA, Duncan R, Goldstein LH, Reuber M. Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: a staged approach: a report from the International League Against Epilepsy Nonepileptic Seizures Task Force. Epilepsia 2013; 54 (11) 2005-2018
43 Selwa LM, Geyer J, Nikakhtar N, Brown MB, Schuh LA, Drury I. Nonepileptic seizure outcome varies by type of spell and duration of illness. Epilepsia 2000; 41 (10) 1330-1334
44 Vinton A, Carino J, Vogrin S. , et al. “Convulsive” nonepileptic seizures have a characteristic pattern of rhythmic artifact distinguishing them from convulsive epileptic seizures. Epilepsia 2004; 45 (11) 1344-1350
45 Benbadis SR, Lancman ME, King LM, Swanson SJ. Preictal pseudosleep: a new finding in psychogenic seizures. Neurology 1996; 47 (01) 63-67
46 Gates JR, Ramani V, Whalen S, Loewenson R. Ictal characteristics of pseudoseizures. Arch Neurol 1985; 42 (12) 1183-1187
47 Seneviratne U, Reutens D, D'Souza W. Stereotypy of psychogenic nonepileptic seizures: insights from video-EEG monitoring. Epilepsia 2010; 51 (07) 1159-1168
48 Azar NJ, Tayah TF, Wang L, Song Y, Abou-Khalil BW. Postictal breathing pattern distinguishes epileptic from nonepileptic convulsive seizures. Epilepsia 2008; 49 (01) 132-137
49 Leis AA, Ross MA, Summers AK. Psychogenic seizures: ictal characteristics and diagnostic pitfalls. Neurology 1992; 42 (01) 95-99
50 Opherk C, Hirsch LJ. Ictal heart rate differentiates epileptic from non-epileptic seizures. Neurology 2002; 58 (04) 636-638
51 Vossler DG, Haltiner AM, Schepp SK. , et al. Ictal stuttering: a sign suggestive of psychogenic nonepileptic seizures. Neurology 2004; 63 (03) 516-519
52 Oliva M, Pattison C, Carino J, Roten A, Matkovic Z, O'Brien TJ. The diagnostic value of oral lacerations and incontinence during convulsive “seizures”. Epilepsia 2008; 49 (06) 962-967
53 Gröppel G, Kapitany T, Baumgartner C. Cluster analysis of clinical seizure semiology of psychogenic nonepileptic seizures. Epilepsia 2000; 41 (05) 610-614
54 Benbadis SR, O'Neill E, Tatum WO, Heriaud L. Outcome of prolonged video-EEG monitoring at a typical referral epilepsy center. Epilepsia 2004; 45 (09) 1150-1153
55 Erba G, Giussani G, Juersivich A. , et al. The semiology of psychogenic nonepileptic seizures revisited: can video alone predict the diagnosis? Preliminary data from a prospective feasibility study. Epilepsia 2016; 57 (05) 777-785
56 Ristić AJ, Mijović K, Bukumirić Z. , et al. Differential diagnosis of a paroxysmal neurological event: do neurologists know how to clinically recognize it?. Epilepsy Behav 2017; 67: 77-83
57 King DW, Gallagher BB, Murvin AJ. , et al. Pseudoseizures: diagnostic evaluation. Neurology 1982; 32 (01) 18-23
58 Trimble MR. Serum prolactin in epilepsy and hysteria. BMJ 1978; 2 (6153): 1682
59 Chen DK, So YT, Fisher RS. ; Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. 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 (05) 668-675
60 Wood BL, Haque S, Weinstock A, Miller BD. Pediatric stress-related seizures: conceptualization, evaluation, and treatment of nonepileptic seizures in children and adolescents. Curr Opin Pediatr 2004; 16 (05) 523-531
61 McDade G, Brown SW. Non-epileptic seizures: management and predictive factors of outcome. Seizure 1992; 1 (01) 7-10
62 Reilly C, Menlove L, Fenton V, Das KB. Psychogenic nonepileptic seizures in children: a review. Epilepsia 2013; 54 (10) 1715-1724
63 LaFrance Jr WC, Reuber M, Goldstein LH. Management of psychogenic nonepileptic seizures. Epilepsia 2013; 54 (Suppl. 01) 53-67
64 Wyllie E, Glazer JP, Benbadis S, Kotagal P, Wolgamuth B. Psychiatric features of children and adolescents with pseudoseizures. Arch Pediatr Adolesc Med 1999; 153 (03) 244-248
65 Goodyer IM. Epileptic and pseudoepileptic seizures in childhood and adolescence. J Am Acad Child Psychiatry 1985; 24 (01) 3-9
66 Irwin K, Edwards M, Robinson R. Psychogenic non-epileptic seizures: management and prognosis. Arch Dis Child 2000; 82 (06) 474-478