Skip to main content
PMC home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 2000 Jun;82(6):474–478. doi: 10.1136/adc.82.6.474

Psychogenic non-epileptic seizures: management and prognosis

K Irwin 1, M Edwards 1, R Robinson 1
PMCID: PMC1718361  PMID: 10833180

Abstract

AIM—To determine the outcome and identify predictive factors in children with psychogenic non-epileptic seizures (PNES).
METHOD—The biographies of 35 children with PNES, attending a tertiary paediatric neurology centre, were reviewed.
RESULTS—Thirty 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.
CONCLUSION—These 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.



Full Text

The Full Text of this article is available as a PDF (112.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aboukasm A., Mahr G., Gahry B. R., Thomas A., Barkley G. L. Retrospective analysis of the effects of psychotherapeutic interventions on outcomes of psychogenic nonepileptic seizures. Epilepsia. 1998 May;39(5):470–473. doi: 10.1111/j.1528-1157.1998.tb01407.x. [DOI] [PubMed] [Google Scholar]
  2. Betts T., Boden S. Diagnosis, management and prognosis of a group of 128 patients with non-epileptic attack disorder. Part II. Previous childhood sexual abuse in the aetiology of these disorders. Seizure. 1992 Mar;1(1):27–32. doi: 10.1016/1059-1311(92)90051-2. [DOI] [PubMed] [Google Scholar]
  3. Boon P. A., Williamson P. D. The diagnosis of pseudoseizures. Clin Neurol Neurosurg. 1993 Mar;95(1):1–8. doi: 10.1016/0303-8467(93)90085-u. [DOI] [PubMed] [Google Scholar]
  4. Buchanan N., Snars J. Pseudoseizures (non epileptic attack disorder)--clinical management and outcome in 50 patients. Seizure. 1993 Jun;2(2):141–146. doi: 10.1016/s1059-1311(05)80119-0. [DOI] [PubMed] [Google Scholar]
  5. Finlayson R. E., Lucas A. R. Pseudoepileptic seizures in children and adolescents. Mayo Clin Proc. 1979 Feb;54(2):83–87. [PubMed] [Google Scholar]
  6. Gumnit R. J., Gates J. R. Psychogenic seizures. Epilepsia. 1986;27 (Suppl 2):S124–S129. doi: 10.1111/j.1528-1157.1986.tb05736.x. [DOI] [PubMed] [Google Scholar]
  7. Holmes G. L., Sackellares J. C., McKiernan J., Ragland M., Dreifuss F. E. Evaluation of childhood pseudoseizures using EEG telemetry and video tape monitoring. J Pediatr. 1980 Oct;97(4):554–558. doi: 10.1016/s0022-3476(80)80008-4. [DOI] [PubMed] [Google Scholar]
  8. Hopkins A. Pseudoseizures. Q J Med. 1989 Jun;71(266):473–475. [PubMed] [Google Scholar]
  9. Ives J. R., Gloor P. A long term time-lapse video system to document the patients spontaneous clinical seizure synchronized with the EEG. Electroencephalogr Clin Neurophysiol. 1978 Sep;45(3):412–416. doi: 10.1016/0013-4694(78)90193-1. [DOI] [PubMed] [Google Scholar]
  10. Krumholz A., Niedermeyer E. Psychogenic seizures: a clinical study with follow-up data. Neurology. 1983 Apr;33(4):498–502. doi: 10.1212/wnl.33.4.498. [DOI] [PubMed] [Google Scholar]
  11. Lancman M. E., Asconapé J. J., Graves S., Gibson P. A. Psychogenic seizures in children: long-term analysis of 43 cases. J Child Neurol. 1994 Oct;9(4):404–407. doi: 10.1177/088307389400900413. [DOI] [PubMed] [Google Scholar]
  12. Luther J. S., McNamara J. O., Carwile S., Miller P., Hope V. Pseudoepileptic seizures: methods and video analysis to aid diagnosis. Ann Neurol. 1982 Nov;12(5):458–462. doi: 10.1002/ana.410120508. [DOI] [PubMed] [Google Scholar]
  13. Metrick M. E., Ritter F. J., Gates J. R., Jacobs M. P., Skare S. S., Loewenson R. B. Nonepileptic events in childhood. Epilepsia. 1991 May-Jun;32(3):322–328. doi: 10.1111/j.1528-1157.1991.tb04658.x. [DOI] [PubMed] [Google Scholar]
  14. Roy A. Hysterical fits previously diagnosed as epilepsy. Psychol Med. 1977 May;7(2):271–273. doi: 10.1017/s0033291700029366. [DOI] [PubMed] [Google Scholar]
  15. Scull D. A. Pseudoseizures or non-epileptic seizures (NES); 15 synonyms. J Neurol Neurosurg Psychiatry. 1997 Feb;62(2):200–200. doi: 10.1136/jnnp.62.2.200-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Stewart R. S., Lovitt R., Stewart R. M. Are hysterical seizures more than hysteria? A research diagnostic criteria, DMS-III, and psychometric analysis. Am J Psychiatry. 1982 Jul;139(7):926–929. doi: 10.1176/ajp.139.7.926. [DOI] [PubMed] [Google Scholar]
  17. Trimble M. R. Pseudoseizures. Neurol Clin. 1986 Aug;4(3):531–548. [PubMed] [Google Scholar]
  18. Trimble M. R. Serum prolactin in epilepsy and hysteria. Br Med J. 1978 Dec 16;2(6153):1682–1682. doi: 10.1136/bmj.2.6153.1682. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Trimble M. Pseudo problems pseudoseizures. Br J Hosp Med. 1983 Apr;29(4):326–333. [PubMed] [Google Scholar]
  20. Vanderzant C. W., Giordani B., Berent S., Dreifuss F. E., Sackellares J. C. Personality of patients with pseudoseizures. Neurology. 1986 May;36(5):664–668. doi: 10.1212/wnl.36.5.664. [DOI] [PubMed] [Google Scholar]
  21. Volow M. R. Pseudoseizures: an overview. South Med J. 1986 May;79(5):600–607. doi: 10.1097/00007611-198605000-00020. [DOI] [PubMed] [Google Scholar]
  22. Williams D. T., Spiegel H., Mostofsky D. I. Neurogenic and hysterical seizures in children and adolescents: differential diagnostic and therapeutic considerations. Am J Psychiatry. 1978 Jan;135(1):82–86. doi: 10.1176/ajp.135.1.82. [DOI] [PubMed] [Google Scholar]
  23. Wyllie E., Friedman D., Lüders H., Morris H., Rothner D., Turnbull J. Outcome of psychogenic seizures in children and adolescents compared with adults. Neurology. 1991 May;41(5):742–744. doi: 10.1212/wnl.41.5.742. [DOI] [PubMed] [Google Scholar]
  24. Wyllie E., Friedman D., Rothner A. D., Luders H., Dinner D., Morris H., 3rd, Cruse R., Erenberg G., Kotagal P. Psychogenic seizures in children and adolescents: outcome after diagnosis by ictal video and electroencephalographic recording. Pediatrics. 1990 Apr;85(4):480–484. [PubMed] [Google Scholar]
  25. Wyllie E., Lüders H., MacMillan J. P., Gupta M. Serum prolactin levels after epileptic seizures. Neurology. 1984 Dec;34(12):1601–1604. doi: 10.1212/wnl.34.12.1601. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES