Psychogenic Nonepileptic Seizures (Pseudoseizures)

Hema Patel; David W. Dunn; Joan K. Austin; Julia L. Doss; W. Curt LaFrance; Sigita Plioplys; Rochelle Caplan

doi:10.1542/pir.32-6-e66

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Hema Patel, MD*
David W. Dunn, MD*^†
Joan K. Austin, PhD, RN^§
Julia L. Doss, PsyD^‡
W. Curt LaFrance Jr, MD, MPH**
Sigita Plioplys, MD^§§
Rochelle Caplan, MD^††

^*Section of Child Neurology, Department of Neurology, Indiana University School of Medicine, Indianapolis, IN.
^†Section of Child Psychiatry, Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN.
^§Indiana University School of Nursing, Indianapolis, IN.
^‡Minnesota Epilepsy Group, St. Paul, MN.
^**Department of Neuropsychiatry and Behavioral Neurology, Brown Medical School, Rhode Island Hospital, Providence, RI.
^§§Department of Psychiatry and Behavioral Sciences, Northwestern University's Feinberg School of Medicine, Chicago, IL.
^††Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA.

Author Disclosure
Drs Patel, Dunn, Austin, Doss, LaFrance, Plioplys, and Caplan have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Objectives

After completing this article, readers should be able to:

Recognize the antecedent stressors associated with psychogenic nonepileptic seizures in children.
Identify pediatric nonepileptic seizures clinically.
Distinguish psychogenic nonepileptic seizures from epileptic seizures and other paroxysmal nonepileptic events.
Be aware of the comprehensive assessment needed to evaluate the child who has possible psychogenic nonepileptic seizures.
Become familiar with the management approaches used to treat psychogenic nonepileptic seizures in children.

Definition

Nonepileptic seizures are episodic behavioral events that mimic epileptic seizures but are not associated with abnormal cortical electrical discharges. Psychogenic nonepileptic seizures (PNES) are related to an underlying psychological stressor or conflict and differ from other paroxysmal nonepileptic events. A variety of terms have been used in the literature to describe these events, including hysterical epilepsy, hysteroepilepsy, psychogenic seizures, pseudoepileptic seizures, pseudoseizures, and nonphysiologic or functional seizures. The term psychogenic nonepileptic seizure is preferred because it is nonpejorative and neutral, although there is continuing discussion regarding the most appropriate terminology.

Demographics

PNES are common. Although population data are limited, one report suggested a prevalence of 2 to 33 per 100,000, basing the estimate on an assumption that 10% to 20% of patients seen in an epilepsy center would be found to have PNES. (1) Reviewing video-electroencephalography (EEG) monitoring records, Patel and associates (2) and Wyllie and colleagues (3) found that 3.5% and 7% of children, respectively, seen in clinic for assessment of persistent seizures had PNES. PNES occur in both elementary-age children and in adolescents as well as in all age groups of adults. (2)(3)(4)(5)(6) A female preponderance has been …