Pediatric Psychogenic Nonepileptic Seizures in the Emergency Department: Recognition and Interventions

The emergency department (ED) is usually the first setting in which children with nonepileptic seizures (NES) seek medical assistance. Most patients with NES who are evaluated in the ED are mistaken for having generalized tonic-clonic seizures or status epilepticus. An accurate diagnosis in the ED may be precluded by the clinical presentation of NES, which is often similar to epileptic seizures, and by limited access to electroencephalography, consulting child neurologists, and child psychiatrists. It is imperative to diagnose patients with psychogenic NES early because the prolonged course of this illness is a risk factor for treatment resistance and poor long-term outcome. Timely identification of NES and referral to mental health professionals can be effectively provided by the ED team. This article will discuss the differential diagnosis of psychogenic NES and provide practical strategies for management in the ED.