Epileptic vs. Non Epileptic Seizures in Children: A Diagnostic Dilemma

Volume 4 Issue 10 Oct 2014

Psychogenic non-epileptic seizures (PNES) often misdiagnosed as epilepsy, are episodes which alter neurologic function resembling an epileptic seizure but are not accompanied by electrophysiological changes seen with epilepsy.
Majority of patients are females of age 15 to 35 years. The pre-disposing factors may include prior abuse (sexual and
non-sexual), psychiatric co-morbidities, chronic systemic conditions and personality subtype or other stressors. 10-
15% may have co-existent epileptic seizures. Some may have relatives with epilepsy as a role model.

The semiologies may include rhythmic, non-rhythmic or complex motor activities, prolonged motionless
unresponsiveness (dialeptic), subjective sensations (non-epileptic auras) or mixed. The clinical clues for PNES may
include “ictal” eye closure, “ictal” weeping, fluctuating motor activity with pauses, lack of autonomic features,
prolonged duration (often lasting few minutes to hours) with frequent “status” and brief “post-ictal” states. Lack of
objective evidence of injury, occurrence in presence of “significant others” and ‘La belle indifference’ (i.e. relative
lack of concern about symptoms) are other features. There is typically absence of urinary incontinence and tongue
bite. These events may be precipitated in the clinic/EEG laboratory by various induction maneuvers. Elaborate
laboratory testing is usually not warranted.

In treatment, supportive psychotherapy and family therapy with treatment of co-existent co-morbidities may be
prudent. Many of these patients may be on anti-convulsant drugs which need to be stopped with tapering schedule. It
is to be remembered that anti-convulsant drug toxicity may increase the frequency or cause dramatic changes in the
pattern of PNES.

It is also to be noted that several paroxysmal disorders in childhood may mimic epileptic seizures. These include
paroxysmal dyskinesias, episodic ataxias, childhood periodic syndromes (e.g. benign paroxysmal vertigo, benign
paroxysmal torticollis of infancy, etc), benign myoclonus, shuddering attacks, self-stimulation/masturbation etc.
Hence the presentation of abnormal movements in children needs an elaborative and holistic approach towards
diagnosis and management.

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