A multisite controlled study of risk factors in pediatric psychogenic nonepileptic seizures
Abstract
Summary: Objective: Psychogenic nonepileptic seizures (PNES) in youth are symptoms of a difficult to diagnose and treat conversion disorder. PNES is associated with high medical and psychiatric morbidity, but specific PNES risk factors in the pediatric population are not known. We examined if youth with PNES have a distinct biopsychosocial risk factor profile compared to their siblings and if the interrelationships between these risk factors differentiate the PNES probands from the sibling group. Methods: This multisite study included 55 youth with a confirmed diagnosis of PNES (age range 8.6–18.4 years) and their 35 sibling controls (age range 8.6–18.1 years). A video EEG and psychiatric assessment confirmed the PNES diagnosis. Parents reported on each child's past and present medical/epilepsy, psychiatric, family, and educational history. Each child underwent a structured psychiatric interview, standardized cognitive and academic achievement testing, and completed self‐report coping, daily stress, adversities, and parental bonding questionnaires. Results: Compared to their siblings, the PNES probands had significantly more lifetime comorbid medical, neurological (including epilepsy), and psychiatric problems; used more medications and intensive medical services; had more higher anxiety sensitivity, practiced solitary emotional coping, and experienced more lifetime adversities. A principal components analysis of these variables identified a somatopsychiatric, adversity, epilepsy, and cognitive component. The somatopsychiatric and adversity components differentiated the probands from the siblings, and were highly significant predictors of PNES with odds ratios of 15.1 (95% CI [3.4, 67.3], and 9.5 (95% CI [2.0, 45.7]), respectively. The epilepsy and cognitive components did not differentiate between the PNES and sibling groups. Significance: These findings highlight the complex biopsychosocial and distinct vulnerability profile of pediatric PNES. They also underscore the need for screening the interrelated risk factors included in the somatopsychiatric and adversity components and subsequent mental health referral for confirmation of the diagnosis and treatment of youth with PNES.
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Children with PNES have greater catastrophic symptom expectations.
“Children with PNES have greater catastrophic symptoms expectations such as, “When my head is pounding, I worry I could have a stroke,””
From Retraining and control therapy for pediatric psychogenic non-epileptic seizures (2020) · cites this paper as [13]
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- Authors
- Plioplys, S., Doss, J., Siddarth, P., Bursch, B., Falcone, T., Forgey, M., Hinman, K., LaFrance, W. C., Laptook, R., Shaw, R. J., Weisbrot, D. M., Willis, M. D., & Caplan, R.
- Affiliations
- Northwestern University (US)
- Minnesota Epilepsy Group (US)
- University of California, Los Angeles (US)
- Cleveland Clinic (US)
- Lucile Packard Children's Hospital (US)
- Department of Child and Family Psychiatry Warren Alpert Medical School of Brown University Rhode Island Hospital Rhode Island Rhode Island U.S.A
- Brown University (US)
- Stony Brook University Hospital (US)
- Corresponding author
- Plioplys, Sigita
- ORCID
- Venue
- Epilepsia
- Publisher
- Wiley
- Published
- 2014-09-19
- Volume
- 55
- Issue
- 11
- Pages
- 1739-1747
- ISSN
- 0013-9580 (ISSN-L)
- 1528-1167
- OpenAlex
- W2131764522
- Cited by
- 124
- References
- 41
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 6 · 2023: 7 · 2022: 12 · 2021: 8 · 2020: 14 · 2019: 13 · 2018: 16 · 2017: 16 · 2016: 10 · 2015: 6
- FWCI
- 8.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Epilepsia (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Epilepsy Foundation
- Department of Child and Adolescent Psychiatry
- Feinberg School of Medicine at Northwestern University
- UCLA Semel Institute for Neuroscience and Human Behavior
- 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, risk factors, biopsychosocial model, childhood adversity, anxiety sensitivity, coping strategies, parental bonding, psychiatric comorbidity, epilepsy, siblings
- MeSH terms
- Adolescent, Child, Conversion Disorder, Diagnosis, Differential, Electroencephalography, Female, Humans, Male, Psychophysiologic Disorders, Risk Factors, Seizures, Siblings
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