Paroxysmal nonepileptic events in pediatric patients confirmed by long-term video-EEG monitoring — Single tertiary center review of 143 patients

The purpose of the study was to evaluate the clinical characteristics of paroxysmal nonepileptic events (PNEs) in pediatric patients. Reports of 1108 patients who underwent long-term video-EEG monitoring at Seoul National University Children's Hospital were reviewed retrospectively. One hundred forty-three (12.9%) patients were diagnosed as having PNEs. The most common type of PNE was staring. Staring, tonic posturing, sleep myoclonus, and sleep-related disorders were more common in patients younger than 6 years old. Psychogenic nonepileptic seizure was the most common PNE in patients older than 6 years. Patients who were younger than 6 years old showed shorter disease duration and more varied types of PNEs when compared to older patients (6 years old or older). Presence of epilepsy was not significantly related to clinical difference in PNEs. In patients with developmental delay, staring and tonic posture were significantly more frequent than patients without developmental delay. Thirty-two patients without concurrent epilepsy were misdiagnosed with epilepsy, and AEDs were discontinued after the correct diagnosis of PNEs. Whenever the diagnosis of paroxysmal abnormal behavior is uncertain, correct diagnosis should be made using long-term video-EEG monitoring, especially in younger pediatric patients and patients with developmental delay.

► PNEs were diagnosed in 12.9% of video-EEG monitored patients.
► Type of PNEs was more variable in younger children.
► Staring and tonic posturing were more frequent in patients with developmental delay.
► Rate of misdiagnosis of PNEs as epilepsy was 23.4%.
► Video-EEG monitoring is critical for correct diagnosis of PNEs.