Psychogenic nonepileptic seizures (pseudoseizures)

Based primarily on consensus due to lack of relevant clinical studies, it is difficult to distinguish PNES from epileptic seizures. Failure to make this distinction may result in lack of appropriate management and a decline in the quality of life for the child and family. Based on some research evidence as well as consensus, common associated stressors in children include school difficulties, family discord, and interpersonal conflicts with peers and friends, with sexual abuse being less common than in adults. Anxiety and depression commonly are associated with PNES. (2)(3)(4) PNES should be differentiated from other paroxysmal nonepileptic events. Based on strong research evidence, prolonged video-EEG monitoring is the gold standard in making a definitive diagnosis. (5)(6) Based on some research evidence as well as consensus, early diagnosis and referral to a psychiatrist or psychologist for treatment of the underlying psychopathology with individual and family therapy are the mainstay of successful management of pediatric NES due to psychological causes. Children who have PNES have a better prognosis than adults.