Children with psychogenic non-epileptic seizures (PNES): A detailed semiologic analysis and modified new classification

Purpose: To analyze children with psychogenic non epileptic seizures and propose a modified new classification. Methods: This retrospective analysis included 56 children aged <18 years (M:F = 26:30; mean age: 12.3 ± 4.0 years) diagnosed PNES on video-EEG monitoring. The semiological characteristics like pattern of bodily movements, emotional signs, stereotypy, ictal vocalization, responsiveness, delay in diagnosis etc. were recorded. We analyzed our data as per previous adult classifications and proposed a modified classification. Results: There were 190 recorded attacks (range: 1–9, median: 3) recorded. The age at onset of PNES was 8.9 ± 4.1 years (range: 0.4–15.8 years; median: 9 years), age at diagnosis: 11.9 ± 4.1 years (range: 2–17; median: 12.0 years), delay in diagnosis: 3.2 ± 3.7 years (range: 0–15; median: 2.0 years). Anxiety disorder was seen in 9 (16.1%), stress in 6 (10.7%) children. Flexion/extension bodily movements were seen in 40 (70.1%), negative emotional signs in 17 (30.4%) and tremors in 14 (25%) cases. Thirty-three (58.9%) patients diagnosed as having true seizures initially and were on anti-epileptic drugs (AEDs), 14 patients (25.0%) initially diagnosed of PNES which remained unchanged after VEEG, nine patients (16.1%) had both PNES and true seizures. Twenty-six (46.4%) of our patients into the existing classifications. We then classified our patients into categories of a modified new classification: Hypermotor: 13 (23.2%), partial motor: 8 (14.3%), affective/emotional behaviour phenomena: 2 (3.6%), dialeptic: 8 (14.3%), ‘aura’: 3 (5.4%), mixed: 22 (39.3%). Conclusion: Incorrect diagnosis of epilepsy leads to unnecessary drug treatment. A detailed analysis of semiology and classification helps in early diagnosis of PNES. A modified systematic classification of PNES is proposed which would help in better standardization of PNES.