Application of a Recently Proposed Semiological Classification to Psychogenic Nonepileptic Seizures in Children

Objectives: Although different psychogenic nonepileptic seizures (PNES) classifications have been proposed in recent years, there is still no common classification. The aim of this study is to examine the semiological features of PNES in children and to evaluate interobserver reliability of two different classifications. Methods: Semiological features of 36 pediatric patients with PNES with and without epilepsy were analyzed. Two different, blind observers evaluated these semiological features according to A. Asadi P. and Seneviratne et al. classifications. The interobserver reliability was measured using a kappa (κ) coefficient for each PNES classification. Results: Ictal eye closure (n:30, 83.3%), was the most common seizure semiology. Asymmetric limb movements (n:22, 61.1%), motor phenomenon lasting> two minutes (n:20, 55.5%), and closed mouth (n:14, 38.8%) were other common seizure semiologies of PNES. Kappa value was higher in A. Asadi-Pooya classification than Seneviratne classification (k=0.697 and k= 0.433; p<0.05). Kappa values were higher in the motor and non-motor categories of A. Asadi-Pooya classification than in the mixed category (k=0.713, k= 0.799 and k=0.455; p<0.05). Conclusion: Interobserver reliability of the A. Asadi-Pooya classification was substantial as compared with the detailed classification, which was fair. It is necessary to ensure the reliability of clinical classifications of PNES for a common language in the diagnosis and path to diagnosis. Our findings suggest that a simple but comprehensive classification would be useful in the management of PNES.
Keywords: PNES, psychogenic nonepileptic seizures, children, classification