Pediatric functional seizures: Demographics, clinical and psychological characteristics and risk factors.

The prevalence, semiology, comorbidities and predictors of pediatric functional seizures (FS) [also known as psychogenic non-epileptic seizures (PNES)] are greatly understudied compared to adults. We aimed to determine the prevalence in the epilepsy clinics, clinical patterns, behavioral characteristics and risk predictors for pediatric FS. Patients were recruited from the outpatient pediatric epilepsy clinics of tertiary referral hospitals. During the study, the total number of attended patients and diagnosed as epilepsy was 350. Data collection included demographics, clinical features, video records for seizure-like concerns and electroencephalography records. The prevalence of FS was 15.42 % (54/350; boy = 24, girl = 30), among were 5.14 % (18/350) had mixed epilepsy and FS. Detailed behavioral assessment was done for a total of 210 (boys = 84; girls = 126), among were 156 had epilepsy, 36 (boys = 9; girls = 27) with FS and 18 (boys = 15; girls = 3) had mixed epilepsy and FS. This included psychiatric interviewing and application of psychometric questionnaires including Child Behavior Check List (CBCL6/18) and psychosocial risks. Patients with FS were predominantly adolescents (66.7 % or 36/54) with mean age of ∼ 14 years. The delay in diagnosis of FS was 4-14 months. FS semiology included motor (n = 36) and unresponsiveness (n = 18) attacks. Compared to controls and patients with epilepsy, those with FS had higher Total Scores of CBCL and its subsets (anxiety, somatization and inattention) and scores of Internalizing (P = 0.0001; P = 0.015) and Externalizing (P = 0.0001; P = 0.027) Behavior Problems. The psychosocial predictors with FS included self-efficacy conflicts and school and family problems. To conclude, FS are frequent conditions in pediatric epilepsy clinics (∼15 %) and are misdiagnosed and mistreated as epilepsy. Their early diagnosis and management are critical to prevent problems in personality and social and school activities.