Pediatric Hospital Medicine

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Part I • Neurology

3. Bergey GK. Management of a first seizure. Continuum (Minneap Minn) . 2016;22 (1 Epilepsy):38-50. 4. Hirtz D, Ashwal S, Berg A, et al. Practice parameter: evaluating a first nonfebrile seizure in children: report of the quality standards subcommittee of the American Academy of Neurology, The Child Neurology Society, and The American Epilepsy Society. Neurology . 2000;55(5):616-623. 5. Hirtz D, Berg A, Bettis D, et al. Practice parameter: treatment of the child with a first unprovoked seizure: report of the quality standards subcommittee of the American Acad emy of Neurology and the Practice Committee of the Child Neurology Society. Neurol ogy . 2003;60(2):166-175.

PSYCHOGENIC NONEPILEPTIC SEIZURES ■ INTRODUCTION

Psychogenic nonepileptic seizures (PNES) are paroxysmal events char acterized by changes in behavior without corresponding EEG abnor malities and are not due to cerebral dysfunction. 1 PNES are observable, have rapid onset, and are thought to have a psychogenic origin. 2 ■ EPIDEMIOLOGY AND RISK FACTORS PNES have been studied extensively in adults, and true incidence and prevalence in the pediatric population are unknown. School-age chil dren and more commonly adolescents tend to be affected, and the prev alence is greater in females. Patients are often misdiagnosed as having epilepsy and incorrectly treated with antiepileptic drugs. 1-3 Risk factors include the following: • School-related problems • Family discordance • Interpersonal conflicts • Physical and sexual abuse • Psychiatric comorbidities, such as, anxiety, depression, eating disor ders, posttraumatic stress disorder, and somatization • Neurologic and medical comorbidities, such as history of head trauma, intellectual disability, headaches, and chronic illnesses • Concurrent seizure disorder 1 ■ CLINICAL MANIFESTATIONS PNES are repeated paroxysmal events that are refractory to appropri ate medical therapy, initiated in response to specific stressors or trig gers, and uniquely occur only when spectators are around. 1,3 Close observation of the event frequently leads to the correct diagnosis. See Table 2.11 for other characteristic clinical features.

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