Outcome of psychogenic nonepileptic seizures (PNES) in children: A 2-year follow-up study

•90 children with PNES diagnosed on video-EEG were followed for 2 years.•The 2-year remission rate of PNES in children was 55%.•Patients with more chronic symptoms of PNES had worse outcome.•Presence of epilepsy was associated with decreased remission rate for PNES.

ObjectiveThe objective of this study was to determine the outcome of psychogenic nonepileptic seizures (PNES) in children seen at a level 4 epilepsy center.MethodsWe retrospectively analyzed patients under the age of 18 years who were diagnosed with PNES based on evaluation in the epilepsy monitoring unit and had a follow-up of at least 2 years postdiagnosis. Remission of events was noted at 6 months, 12 months, and 24 months of follow-up, and patient and disease variables affecting outcome were studied.ResultsNinety patients met inclusion criteria (58 females; mean age: 14.03 ± 3.3 years). Thirty-two out of ninety (36%) patients had early (within 6 months) and sustained remission (until 2 years of follow-up) of their events (“favorable outcome”), while 30/90 patients (33%) never achieved remission during the study period (“unfavorable outcome”). The factors that were associated with “unfavorable outcome” included the presence of comorbid epilepsy [12/30 (40%) vs 0/32, p < 0.0001] and prolonged duration of symptoms before establishment of the diagnosis (median 365 days vs 60 days, p < 0.0001). Patient's age, gender, frequency of events, the presence of major psychosocial stressors, and comorbid psychiatric conditions had no significant impact on the disease outcome.ConclusionsAbout a third of children with PNES achieve early and sustained remission of symptoms, while another third continue to manifest seizure-like events until at least two years after the diagnosis. The presence of comorbid epilepsy and prolonged duration of PNES are associated with a poor two-year outcome. Early suspicion and diagnosis of PNES, especially in patients with epilepsy, is essential.