Abstracts

Rationale:
Paroxysmal non-epileptic events (NEEs) are frequently referred to child neurology clinics for seizure evaluation. There is a wide spectrum of NEEs that varies based on age. Many types of NEEs can be diagnosed by clinical history or home videos. Recent studies based on long-term video monitoring (LTVM) often exclude typical NEEs seen in the outpatient setting. We examined the clinical spectrum of NEEs in pediatric patients presenting to the regional New Onset Seizure clinic (NOSc).
Method:
Retrospective chart review was performed on patients evaluated in the NOSc at Children’s Healthcare of Atlanta from September 22, 2015 to March 22, 2018. Exclusion criteria included neonates, patients diagnosed with epileptic seizures, and patients who did not complete recommended diagnostic tests. Two board-certified child neurologists confirmed the diagnosis of NEEs based on history and routine EEGs. Video of event or LTVM were sometimes available. Analysis of NEEs was performed based on the following age subgroups: Group A) Infant, toddler, and preschool (1 month to 5 years); Group B) School-age (5 to 12 years); and Group C) Adolescent (12-18 years).
Results:
Of 2,107 pediatric patients evaluated in NOSc, 300 patients (14%) had NEEs. Average age was 6.7 years ±5.5, and 52% of patients were boys. Routine EEG’s were performed in 285 (95%) and LTVM, in 31 (10%). Of 82 imaging studies (27%), 74/82 (90%) was normal. Diagnosis of NEE was accomplished by history alone in 15 (5%), history and routine EEG in 246 (82%), and with LTVM in 39 (13%). 16 children (5%) were taken off antiseizure medication (ASM) prescribed in the emergency department. Top three NEE were staring spell (N=71, 24%), syncope (N=42, 14%), and psychogenic nonepileptic spells (PNES; N=39, 13%). Top 3 by age group are as follows: Group A) staring spells (N=42/146, 29%), breath-holding spells (N=23/146, 16%), sleep-related events (N=19/146, 13%); Group B) staring spells (N=26/90, 29%), syncope (N=20/90, 22%), PNES (N=14/90, 16%); Group C) PNES (N=24/64, 38%), syncope (N=15/64, 23%), migraine (N=10/64, 16%).
Conclusion:
In our tertiary outpatient NOSc, diagnosis of NEE was made by history with ancillary routine EEG in 82% of patients and by history alone in additional 5%, emphasizing the importance of history and clinician experience. Pediatric neurology evaluation and consequently diagnosis of NEE can be delayed and lead to unnecessary commitment to ASM. Diagnosis of NEE allowed for discontinuation of ASM in 5% of children. The likely NEEs vary by age group with staring spells predominant in younger age groups and PNES in adolescents. In contrast to studies based on LTVM, PNES is common in children over 5 years and increases with age.
Funding:
:None