A multisite controlled study of risk factors in pediatric psychogenic nonepileptic seizures

作者：Plioplys Sigita^*; Doss Julia; Siddarth Prabha; Bursch Brenda; Falcone Tatiana; Forgey Marcy; Hinman Kyle; LaFrance W Curt Jr; Laptook Rebecca; Shaw Richard J; Wei**rot Deborah M; Willis Matthew D; Caplan Rochelle

来源：Epilepsia, 2014, 55(11): 1739-1747.

DOI：10.1111/epi.12773

• Epilepsy
• Psychogenic
• Nonepileptic seizures
• Conversion disorder
• Risk
• Pediatric

ObjectivePsychogenic nonepileptic seizures (PNES) in youth are symptoms of a difficult to diagnose and treat conversion disorder. PNES is associated with high medical and psychiatric morbidity, but specific PNES risk factors in the pediatric population are not known. We examined if youth with PNES have a distinct biopsychosocial risk factor profile compared to their siblings and if the interrelationships between these risk factors differentiate the PNES probands from the sibling group.
MethodsThis multisite study included 55 youth with a confirmed diagnosis of PNES (age range 8.6-18.4years) and their 35 sibling controls (age range 8.6-18.1years). A video EEG and psychiatric assessment confirmed the PNES diagnosis. Parents reported on each child's past and present medical/epilepsy, psychiatric, family, and educational history. Each child underwent a structured psychiatric interview, standardized cognitive and academic achievement testing, and completed self-report coping, daily stress, adversities, and parental bonding questionnaires.
ResultsCompared to their siblings, the PNES probands had significantly more lifetime comorbid medical, neurological (including epilepsy), and psychiatric problems; used more medications and intensive medical services; had more higher anxiety sensitivity, practiced solitary emotional coping, and experienced more lifetime adversities. A principal components analysis of these variables identified a somatopsychiatric, adversity, epilepsy, and cognitive component. The somatopsychiatric and adversity components differentiated the probands from the siblings, and were highly significant predictors of PNES with odds ratios of 15.1 (95% CI [3.4, 67.3], and 9.5 (95% CI [2.0, 45.7]), respectively. The epilepsy and cognitive components did not differentiate between the PNES and sibling groups.
SignificanceThese findings highlight the complex biopsychosocial and distinct vulnerability profile of pediatric PNES. They also underscore the need for screening the interrelated risk factors included in the somatopsychiatric and adversity components and subsequent mental health referral for confirmation of the diagnosis and treatment of youth with PNES.

• 出版日期2014-11
• 单位西北大学