Pediatric Hospital Medicine

20

Part I • Neurology

TABLE 2.12 HIGH-VALUE APPROACH TO PNES

DIAGNOSTIC STUDIES

TREATMENT

DO

DON’T

DO

DON’T

• Prolonged video EEG

• Routine in terictal EEG (~30 min) • Obtain serum prolactin level. 2,3

• Counsel patient and family on diagnosis in a non judgmental way. • Address underlying comorbid psycho pathology through therapy and/or medications. • Perform psycho educational testing and interventions. • Initiate composite treatment plan at home and school to • minimize physi cal injury during the event, • remove focus from emotional reaction to the event, and • prevent unnec essary hospital izations and use of health care resources. 1-3

• Prescribe

antiepilep tic drugs. 1-3

(~24 h; repeat if necessary to clarify diagnosis)

• Short-term EEG with

provocative techniques, eg, hyperven tilation, photic stimulation, etc, acceptable in resource limited settings 1

• Psychiatric assessment

EEG, electroencephalogram; PNES, psychogenic nonepileptic seizures.

damage is imperative to convince families that antiepileptic drugs are not required. 1-3 See Table 2.12 for recommended treatment of PNES.

■ REFERENCES 1. Patel H, Blake H, Dunn D. Psychogenic nonepileptic seizures in children and adoles cents. Indian Pediatr . 2021;58(3):259-265. 2. Operto FF, Coppola G, Mazza R, et al. Psychogenic nonepileptic seizures in pediatric population: a review. Brain Behav. 2019;9(12):e01406. 3. Patel H, Dunn DW, Austin JK, et al. Psychogenic nonepileptic seizures (pseudoseizures). Pediatr Rev . 2011;32(6):e66-e72.

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