title: Outcome of psychogenic nonepileptic seizures (PNES) in children: A 2-year follow-up study.
abstract: OBJECTIVE
  The objective of this study was to determine the outcome of psychogenic nonepileptic seizures (PNES) in children seen at a level 4 epilepsy center.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Ninety 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.
  
  
  CONCLUSIONS
  About 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.
authors.affiliation: Epilepsy Section, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, OH, USA. Electronic address: ashok.yadavmd@gmail.com.
authors.forename: Ashok
authors.initials: A
authors.lastname: Yadav
authors.affiliation: Epilepsy Section, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, OH, USA. Electronic address: ragarwal@med.wayne.edu.
authors.forename: Rajkumar
authors.initials: R
authors.lastname: Agarwal
authors.affiliation: Epilepsy Section, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, OH, USA. Electronic address: jun.park@uhhospitals.org.
authors.forename: Jun
authors.initials: J
authors.lastname: Park
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003291:Conversion Disorder / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D004569:Electroencephalography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis* / Q000503:physiopathology* / Q000523:psychology; D013001:Somatoform Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D013997:Time Factors; D016896:Treatment Outcome
keywords: Children; Epilepsy; Outcome; Paroxysmal episodes; Psychogenic nonepileptic seizures