Pediatric stress-related seizures: conceptualization, evaluation, and treatment of nonepileptic seizures in children and adolescents.
OBJECTIVE
Nonepileptic seizures are seizure-like symptoms that occur in the absence of epileptogenic brain activity. They can cause severe compromise of daily function and impede development in children, and are frequently misdiagnosed, leading to inadequate or potentially harmful medical treatment. This review will characterize nonepileptic seizures, identify associated factors, propose to a reconceptualization of the phenomenon as stress-related seizures, and suggest guidelines for valid diagnosis and intervention.


RESULTS
Nonepileptic seizures occur in 10 to 20% of children who present to epilepsy centers, and are more common in females. Early intervention improves prognosis. Factors associated are physical, sexual and other trauma, family dysfunction, and other acute or chronic stressors. They are frequently misdiagnosed and inappropriately treated. Therapy redirecting preoccupation with worries has been effective.


CONCLUSIONS
Nonepileptic seizures are best conceptualized and referred to as stress-related seizures. Long Term Video-EEG Monitoring (LTM) is the gold standard for diagnosis. Diagnosis and intervention requires collaboration between primary care physicians, neurologists, and medically oriented clinicians providing individual and family psychotherapeutic intervention.
Wood
Beatrice L
BL
Division of Child and Adolescent Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA.
Haque
Shabrin
S
Weinstock
Arie
A
Miller
Bruce D
BD
D000293:Adolescent; D002648:Child; D003937:Diagnosis, Differential; D004569:Electroencephalography; D006801:Humans; D010353:Patient Education as Topic; D011379:Prognosis; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D013315:Stress, Psychological / Q000150:complications*; D014743:Videotape Recording