Psychogenic seizures and other nonepileptic paroxysmal events in children

The differential diagnosis of nonepileptic paroxysmal disorders is very broad in children and adolescents, spanning a wide variety of physiologic, organic, and behavioral conditions. Psychogenic nonepileptic seizures (PNES) are the most common psychiatric disorder, but rage and panic attacks may also occur. Other conditions mimicking seizures in children include nonepileptic staring and inattention, stereotyped mannerisms, arousals, hypnic jerks, parasomnias, tics, shuddering attacks, and gastroesophageal reflux with posturing or laryngospasm. Video-EEG monitoring is critical to diagnosis. PNES may be seen in boys or girls as young as 5 or 6 years of age, becoming more common during adolescence when a female predominance first emerges. PNES typically manifest in pediatric patients as episodes of quiet unresponsiveness or as motor events with head and limb movements. Critical to the treatment of PNES in children and adolescents is an accurate, incontrovertible diagnosis based on video-EEG, presented with empathy and confidence. Mood disorders or other psychiatric conditions and severe environmental stress, especially sexual or physical abuse and family dysfunction, must be considered in every case. Acute psychiatric intervention is important to address underlying emotional and environmental conditions and to help the patient learn new coping skills. Prognosis for cessation of PNES appears to be more favorable in children and adolescents than in adults, with 81% of pediatric patients free of events by 3 years after video-EEG diagnosis. (C) 2002 Elsevier Science (USA).