Abstracts

Rationale: Psychogenic non-epileptic seizures (PNES) represent up to 25% of the admissions to inpatient epilepsy monitoring units (Gates, 2000). While PNES, in the adult population, has been extensively studied, far fewer studies have focused exclusively on the pediatric population. Psychiatric comorbidity in adult patients with PNES has been illustrated in a number of studies (Binzer, et. al., 2004; Reuber et. al., 2003, Rueber et. al., 2004). While some pediatric studies demonstrated the existence of psychiatric disorders at the time of diagnosis of PNES, few studies have examined the psychiatric history of these patients. The objective of the present investigation is to describe the psychiatric histories of patients diagnosed with PNES while hospitalized on an inpatient epilepsy monitoring unit. Methods: Records of 39 patients, admitted to the Minnesota Epilepsy Group pediatric epilepsy unit, from January 2004 through May of 2008, and who were subsequently diagnosed with PNES, were retrospectively reviewed. Patients were included if they were diagnosed with PNES by the attending pediatric neurologist, and were formally evaluated by a psychologist. For this study report of psychiatric history was obtained from parents, caregivers, the patient, and review of their medical chart. Results: Of the 39 participants, 71% were female and 29% were male. The ages ranged from 8 to 18 years of age, with the average being 14-years-old. The majority of the participants, 84% (N=33), began experiencing PNES symptoms within 8 months prior to admission and diagnosis to the epilepsy monitoring unit. Overall, 74% (N=29) of the patients in this study reported a history of psychiatric diagnosis, which predated the emergence of the PNES symptoms. Of those with psychiatric diagnoses, 58% (N=17) had received outpatient psychotherapy, 62% (N=18) received psychotropic medication, and 48% (N=14) received both therapy and medication. Psychiatric diagnoses were most often either mood or anxiety disorders with 82% (N=24) falling into these categories. Conclusions: A majority of our sample (74%) had psychiatric diagnoses prior to diagnosis of PNES, and unrelated to the PNES diagnosis. A number of those who had a previous psychiatric diagnoses had received some type of treatment, with the majority receiving both outpatient therapy and psychotropic medication. These preliminary results support the adult literature that individuals diagnosed with PNES frequently have histories of psychiatric diagnosis and treatment. This warrants further investigation into the way in which psychiatric history impacts emergence of PNES symptoms in children and its implications for treatment.