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Cited by 43Psychosomatic Disorders and Their TreatmentsEpilepsy research and treatmentPain Management and Placebo Effect

Psychogenic nonepileptic seizures in children—Prospective validation of a clinical care pathway & risk factors for treatment outcome

Sawchuk, Tyson, Buchhalter, Jeffrey, Senft, Birgit·2020·Epilepsy & Behavior
DOI 10.1016/j.yebeh.2020.106971
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Abstract

Purpose The purpose of this study was to prospectively validate a care pathway for psychogenic nonepileptic seizures (PNES) in a pediatric setting. The pathway was developed based on a previous study of patients at our center, which demonstrated positive treatment outcomes of 80% full or partial remission. Sequentially referred patients with PNES in the validation cohort received care prospectively according to the pathway algorithm. It was hypothesized that the validation cohort would achieve outcomes similar to that of the development cohort as a result of standardized care.Method We performed a retrospective chart review of 43 children sequentially referred, assessed, and treated within a specialized neurology psychology service for suspected PNES over a 5-year period. The majority of patients (n = 41, 95%) met diagnostic criteria for probable, clinically established, or documented PNES, according to the International League Against Epilepsy (ILAE) criteria.Results Ages ranged from 6 to 18 years of age at time of diagnosis, with the majority of patients being female (n = 29, 67%) and adolescent (n = 31, 72%). There was a high level of adherence to the care algorithm (n = 34, 84%). The development and validation cohorts were similar across demographic, clinical, and psychological characteristics. Standardized care resulted in high rates of full (n = 27, 63%) and partial (n = 12, 28%) remission, as self-reported at discharge. A 96% decrease in mean monthly frequency of total PNES events was also observed at discharge, as was a significant reduction in healthcare utilization related to PNES (74% fewer ambulance calls and 85% fewer emergency department (ED) visits). Post hoc analyses demonstrated that duration of PNES illness longer than 12 months (at diagnosis) increased odds of not achieving full remission by discharge (odds ratio = 5.94, p = 0.02). Developmental period of onset (child versus adolescent), having abnormal electroencephalogram (EEG) result, previous concussion, chronic versus acute stressor, more than one PNES event type, or additional functional neurological symptoms did not significantly impact treatment response.Conclusions This study demonstrates, for the first time prospectively in a pediatric setting, that standardized care for PNES leads to improved clinical outcomes and reduced healthcare utilization. Delayed diagnosis and treatment of PNES longer than 12 months also appears to be associated with less favorable outcomes in children.

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  • Personality testing using the MACI with children (n = 20) with functional seizures showed high levels of psychic tension, anxiety, depressive affect, and maladaptive personality traits, suggesting maladaptive patterns of coping.

    “Personality testing using the Millon adolescent clinical inventory (MACI) with children (n = 20) with functional seizures (an FND subtype; see Figure 1) showed high levels of psychic tension, anxiety, depressive affect, and maladaptive personality traits, suggesting maladaptive patterns of coping [62,63].”

    From Illness-Promoting Psychological Processes in Children and Adolescents with Functional Neurological Disorder (2023) · cites this paper as [63]

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Authors
Sawchuk, T., Buchhalter, J., & Senft, B.
Affiliations
  • University of Nicosia (CY)
  • University of Calgary (CA)
Corresponding author
Sawchuk, Tyson
ORCID
Venue
Epilepsy & Behavior
Publisher
Elsevier BV
Published
2020-04
Volume
105
Pages
106971
ISSN
1525-5050 (ISSN-L)
DOI
10.1016/j.yebeh.2020.106971
OpenAlex
W3007767275
Cited by
43
References
40
Citations by year
2026: 3 · 2025: 4 · 2024: 2 · 2023: 11 · 2022: 10 · 2021: 10 · 2020: 3
FWCI
6.20
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Epilepsy & Behavior (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
Keywords
psychogenic non-epileptic seizures, pediatric patients, standardized care pathway, treatment outcomes, remission, health care utilization, emergency department visits, ambulance calls, disease duration, delayed diagnosis, functional neurological symptoms, predictors of treatment response, seizure frequency reduction, stressor type, concussion history, EEG abnormalities, event types, age of onset, sex differences
MeSH terms
Adolescent, Child, Electroencephalography, Emergency Service, Hospital, Female, Humans, Male, Patient Acceptance of Health Care, Prospective Studies, Referral and Consultation, Retrospective Studies, Risk Factors, Seizures, Reproducibility of Results, Cohort Studies, Treatment Outcome, Critical Pathways

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