Non-epileptic paroxysmal events at pediatric video-electroencephalography monitoring unit over a 15-year period

Objective: Non-epileptic paroxysmal events(NEPEs) are common in pediatric patients and may be misdiagnosed as epileptic seizures. It could be difficult to differentiate seizures and NEPE in childhood. The gold standard for accurate diagnosis of NEPE is to capture the attacks during video-electroencephalography(EEG) monitoring. Methods:We retrospectively evaluated patients admitted to the video-EEG monitoring unit between 2009- 2020. Inclusion criteria were age >1 month and <18 years and the diagnosis of NEPE established by video-EEG monitoring. We assessed the age of onset, medical history, family history, semiology, previous EEG, medications, video-EEG recordings, brain MRI and outcome. Results:A total of 1338 records were evaluated retrospectively. NEPE was diagnosed in 226(19.3%) of 1173 patients (M/F: 119/107). The mean age at the time of video-EEG monitoring was 105.4±64.4 months(2-216), and the mean age at the time of onset of symptoms was 82.5±63.3 months(0,04-211). Jerking was the most common feature(n=40, 17.7%), and motor findings accounted for 65.9%(149) of the presenting symptoms. Almost half of the patients had a prior diagnosis of epilepsy (n=105, 46.5%). 35 (15.5%) patients had global developmental delay. The most common NEPEs were PNES (n=66, 29.2%), movement disorders (n=46, 20.4%), physiological motor movements during sleep (n=33, 14.6%), normal behavioral events (n=31, 13.7%), and sleep disorders (n=15, 6.6%). Following the diagnosis of NEPE, antiseizure medication was discontinued in 56 (24.8%) patients. Conclusion: NEPE is a difficult clinical condition to diagnose and treat in childhood. Correct diagnosis of NEPE by video-EEG prevents unnecessary ASM exposure in children, and guides appropriate management of NEPE.
Keywords: Non-epileptic events, video-EEG monitoring, pediatric patients