Article
Psychogenic non-epileptic seizures: management and prognosis
Kate Irwin, Melinda Edwards, Richard Robinson
Paediatric Neurology
Department, Newcomen Centre, Guy's Hospital, London SE1, UK
Correspondence to: Dr Irwin email: cjgroves{at}lineone.net
Accepted 11 October
1999
AIM
To determine the
outcome and identify predictive factors in children with psychogenic
non-epileptic seizures (PNES).
METHODThe biographies
of 35 children with PNES, attending a tertiary paediatric neurology
centre, were reviewed.
RESULTSThirty five children attending the department between
1987 and 1997 were evaluated at a mean follow up of 4.6 years. The age range was 6-18 years. Twenty four were girls and 11 were boys. Eleven
patients had a diagnosis of epilepsy with PNES, the remainder having
PNES alone. Cause fell into four categories: a history of violence,
abuse, or neglect; a high level of anxiety; dysfunctional family
relationships; and attention seeking or avoidance behaviour. Management
in all but five cases involved assessment and follow up by a child
psychologist or child psychiatrist. The outcome was encouraging, with
66% of patients becoming PNES free. A further 23% have > 50%
reduction in the frequency of PNES. Only two have had no reduction.
Outcome was best in the group without epilepsy.
CONCLUSIONThese
results suggest that the prognosis of PNES is better in children than
in adults, perhaps because causes are more likely to be external to the
child, more easily identified, and more amenable to prompt
intervention. The importance of good assessment, good communication,
and a treatment plan that includes both symptom management and
addressing the precipitating and perpetuating factors is emphasised.
Keywords: psychogenic seizures; pseudoseizures; non-epileptic seizures; epilepsy
© 2000 by Archives of Disease in Childhood
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Arch. Dis. Child. 2000 82: 0.[Extract] [Full Text]
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