This material was presented in the 25th European Congress of Psychiatry which was organised by the European Psychiatry Association in Florence, Italy from 1-4th April 2017. I had access to the material as I attended the full Congress. Please note that this material remains the intellectual property of the European Psychiatry Association and its authors and any citation should include a full reference to it. For more information on the EPA and how to become a member, please visit: http://www.europsy.net/

1. Queiroga, L.1 ; Rodrigues, R.1; Mesquita Reis, J.1
1. Child and Adolescent Psychiatry Trainee, CHLC; Dona Estefânia Hospital, CHLC, Lisbon; upi@chlc.min-saude.pt 218530733
RESULTS/DISCUSSION:
Conversion disorders, such as psychogenic non-epileptic
seizures (PNES), are poorly understood and difficult to diagnose.
Their complex clinical presentation involves medically
unexplained symptoms and internalizing disorders (anxiety and
depression). PNES youth have more severe and prevalent
comorbid psychopathology, such as internalizing disorders,
posttraumatic stress disorder (PTSD), anxiety sensitivity and
somatization than their siblings (6).
According to Plioplys et al.
these patients also demonstrated more passive coping behaviors
(solitary yelling, hitting, crying) compared with their siblings,
interpreted by the authors as evidence of increased use of
passive/ avoidant coping strategies among pediatric patients with
PNESs (6). In the general child population risk factors for
internalizing disorders, PTSD, somatization, and anxiety
sensitivity include female gender (among adolescents), cognitive,
and learning difficulties, life adversities, bullying, and single
parent families (6).
Some studies demonstrated high prevalence of adolescents
evidenced one or more maladaptive personality patterns. That the
most prevalent maladaptive personality traits were inhibited,
submissive, and introversive patterns (7).
Despite the comorbid psychopathology contributes to the
difficulties diagnosing PNES, knowledge about the specificity of
the risk factors for comorbid psychopathology in youth with PNES
might facilitate their early identification and treatment. It is known
that a failure to make a correct diagnosis also delays the
appropriate treatment being implemented, leading to further
progressive disability and comorbidity.
!
PSYCHOGENIC NONEPILEPTIC SEIZURES
INTRODUCTION: Psychogenic nonepileptic seizures (PNES) are defined as a somatoform conversion disorder manifesting as
paroxysmal events not associated with electroencephalographic (EEG) epileptiform correlates (1). This entity is poorly understood and
often misdiagnosed as epilepsy. It is important to recognize that misdiagnosis leads to inappropriate use of antiepileptic drugs, which
may worsen the course of the disease. Recent studies have suggested that the frequency of psychogenic nonepileptic seizures
ranges from 10 to 23% of referrals to a pediatric epilepsy center (2,3), as well as 60% of children with PNES achieve symptom
improvement and event freedom of symptoms following appropriate treatment (4, 5).
OBJECTIVE: The aim of this study was to conduct a literature review of studies which the purpose was better understand the
etiologies, features, and care outcomes of psychogenic nonepileptic seizures (PNESs) in a pediatric setting.
METHODOLOGY: Articles indexed in the Pubmed database were analyzed as well as books and studies published in scientific
journals.
The International League Against Epilepsy (ILAE) has
recommended vEEG for correlation with captured PNES events,
in combination with consistent history and semiology, as the
“gold standard” for diagnosis of PNESs (8).
Some randomized clinical trial for PNES revealed significant
seizure reduction and improved comorbid symptoms and global
functioning with cognitive behavioral therapy informed
psychotherapy (CBT-ip) for PNES without and with sertraline.
There were no improvements in the sertraline-only or treatment-
as-usual arms (9). These studies supports that appropriate
psychological treatment was associated with high rates of full
remission and partial remission, as self-reported at discharge.
CONCLUSION:
A early identification of the risk factors for comorbid
psychopathology, diagnosis and appropriate care for PNESs
reduces inappropriate medical investigation and therapy,
expedites rates of remission, and decreases health-care
utilization in a pediatric setting.
BIBLIOGRAPHY:
(1) LaFrance, Jr WC. & Devinsky, O. Treatment of nonepileptic seizures. Epilepsy Behav. 2002; 3(5) (suppl):19-23.
(2) Kotagal, P., et al. Paroxysmal nonepileptic events in children and adolescents. Pediatrics 2002;110, e46. (3)
Patel, H.; Scott, E.; Dunn, D. & Garg, B. Nonepileptic seizures in children. Epilepsia 2007; 48:2086–92. (4) Irwin,
K.; Edwards, M. & Robinson, R. Psychogenic non-epileptic seizures: management and prognosis. Arch Dis Child
2000;82:474–8. (5) Chinta, S.; Malhi, P.; Singhi, P. &, Prabhakar, S. Clinical and psychosocial characteristics of
children with nonepileptic seizures. Ann Indian Acad Neurol 2008;11:159–63.(6) Plioplys, S., et al. (2016). Risk
factors for comorbid psychopathology in youth with psychogenic nonepileptic seizures. Seizure 38; 32-37. (7)
Sawchuk, T. & Buchhalter, J. (2015). Psychogenic nonepileptic seizures in children – Psychological presentation,
treatment, and short-term outcomes. Epilepsy & Behaviour 52; 49-56. (8) LaFrance, Jr WC., Baker, GA., et al.
Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: a staged approach, a report from
the International League Against Epilepsy Nonepileptic Seizures Task Force, Epilepsia 2012; 54:2005-12018. (9)
LaFrance Jr, MD.; Grayson, L., et al. Mul%center
Pilot
Treatment
Trial
for
Psychogenic
Nonepilep%c
Seizures:
A
Randomized
Clinical
Trial.
JAMA
Psychiatry
2014.
71:
998-­‐1004.