Abstract
Limited guidance exists regarding the assessment and management of psychogenic non-epileptic seizures (PNES) in children. Our aim was to develop consensus-based recommendations to fill this gap. The members of the International League Against Epilepsy (ILAE) Task Force on Pediatric Psychiatric Issues conducted a scoping review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-SR) standards. This was supplemented with a Delphi process sent to pediatric PNES experts. Consensus was defined as ≥80% agreement. The systematic search identified 77 studies, the majority (55%) of which were retrospective (only one randomized clinical trial). The primary means of PNES identification was video electroencephalography (vEEG) in 84% of studies. Better outcome was associated with access to counseling/psychological intervention. Children with PNES have more frequent psychiatric disorders than controls. The Delphi resulted in 22 recommendations: Assessment—There was consensus on the importance of (1) taking a comprehensive developmental history; (2) obtaining a description of the events; (3) asking about potential stressors; (4) the need to use vEEG if available parent, self, and school reports and video recordings can contribute to a “probable” diagnosis; and (5) that invasive provocation techniques or deceit should not be employed. Management—There was consensus about the (1) need for a professional with expertise in epilepsy to remain involved for a period after PNES diagnosis; (2) provision of appropriate educational materials to the child and caregivers; and (3) that the decision on treatment modality for PNES in children should consider the child's age, cognitive ability, and family factors. Comorbidities—There was consensus that all children with PNES should be screened for mental health and neurodevelopmental difficulties. Recommendations to facilitate the assessment and management of PNES in children were developed. Future directions to fill knowledge gaps were proposed.
| Original language | English |
|---|---|
| Pages (from-to) | 3160-3195 |
| Number of pages | 36 |
| Journal | Epilepsia |
| Volume | 64 |
| Issue number | 12 |
| Early online date | 7 Oct 2023 |
| DOIs | |
| Publication status | Published - 1 Dec 2023 |
Bibliographical note
Funding Information:C. R. is a co‐investigator on a study that has received funding from UCB Pharma (through an educational grant with no editorial involvement). N. J. receives grant funding paid to her institution for grants unrelated to this work from National Institute of Neurological Disorders and Stroke (NINDS) (National Institutes of Health [NIH] U24NS107201, NIH IU54NS100064, 3R01CA202911‐05S1, R21NS122389, R01HL161847). She is the Bludhorn Professor of International Medicine. She receives an honorarium for her work as an Associate Editor of . K. V. received research grants from Sao Paulo Research Foundation (FAPESP) supported by the State of São Paulo and CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico) supported by the Federal Government. She has consulted for UCB Pharma, Takeda, Abbot, PTC, United Medical, ACHE, Prati‐Donaduzzi, Eurofarma, EMS, and Zodiac Pharma from outside the submitted work. She has received unrestricted educational and research support from Prati‐Donaduzzi Pharma. She is a member of the editorial boards of the following journals: (1) (Associate Editor), (2) — (Associate Editor), and (3) . She receives an honorarium for her work as an Associate Editor of . E. W. serves on data safety monitoring boards for Encoded Therapeutics, Neurocrine, and Acadia Therapeutics. M. K. has received honoraria from Angellina Pharma and Zogenix. M. M. has received speaker fees from UCB, Eisai, and Bial; consultancy fees from MEDSCAPE; and receives an honorarium as Editor‐in‐Chief of . J. M. W. receives an honorarium as Associate Editor for and Editor‐in‐Chief for the pediatric neurology subsection of . She is a member of the national advisory board for Sanofi. S. A. has served as a consultant or received honoraria for lectures from Angelini Pharma, Biocodex, Biomarin, Eisai, Jazz Pharmaceutical, Neuraxpharm, Nutricia, UCB Pharma, Xenon, and Zogenix. He has been an investigator for clinical trials for Eisai, UCB Pharma, Xenon and Zogenix. S. A. is Associate Editor for . Other authors have no conflicts of interest to declare. Epilepsia Epilepsy & Behavior Frontiers in Neurology Epilepsy Frontiers in Pediatric Neurology Epilepsy & Behavior Epilepsy & Behavior Epilepsia Frontiers in Neurology Epilepsia
Publisher Copyright:
© 2023 International League Against Epilepsy.
Keywords
- guidelines
- mental health
- pediatric
- practice standards
- pseudoseizure
ASJC Scopus subject areas
- Neurology
- Clinical Neurology
Access to Document
- PNES in children - scoping review (accepted author manuscript)
This is the peer reviewed version of the following article, which has been published in final form at https://doi.org/10.1111/epi.17768. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.