New article on dissociation and depression in children with PNES compared to children with epilepsy

In June, our team (Myers, Trobliger, Bortnik, Zeng, Segal and Lancman) published: “Dissociation and other clinical phenomena in youth with psychogenic non-epileptic seizures (PNES) compared to youth with epilepsy” in the peer-reviewed journal Seizure: European Journal of Epilepsy. The article had some very interesting findings which I will discuss below.

This paper compared 15 youth diagnosed with psychogenic non-epileptic seizures (PNES) to 16 youth diagnosed with epilepsy. The two groups were compared on: measures of dissociation and depression as well as on clinical and demographic characteristics (age of seizure onset, life adversities, individual/family psychiatric history and more).

We found that the groups differed quite significantly on a number of variables. With regard to clinical factors, those with PNES and over half of their families presented with additional psychological diagnoses (along with PNES). Moreover, well over half of those patients reported experiencing life adversities. Of note, life adversities were different than what we tend to see in adults with PNES. Childhood sexual and physical abuse were not the most common type of psychological trauma and instead patients tended to report bullying in school, divorce, family relocation and/or loss of a parent.

Patients with epilepsy presented with much lower rates of personal and family psychiatric histories and only one fourth of youth with epilepsy reported life adversities (which is still a substantial number).

We know that patients with epilepsy tend to present with high rates of psychiatric comorbidities (e.g. depression, anxiety) compared to the general population. So, for our PNES sample to present with such comparably higher rates of psychopathology and life adversities are especially striking.

Another important finding was made on the Trauma Symptom Checklist for Children. Significant differences were observed between youth with PNES and youth with epilepsy on the Overt Dissociation*, Dissociation, and Depression scales. Youth with epilepsy produced lower scores. Scores remained lower in the epilepsy group, even after adjusting for potential effects age, seizure frequency and intellectual quotient.

Where do we go from here? More studies with larger samples are needed. It would also be helpful in a future study to also have parental and teacher data. But for now, the growing number of studies in pediatric PNES are helping us figure out how to best diagnose and treat these youth.