• Clinical and Experimental Pediatrics
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• v.64 no.8
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• pp.384-392
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• 2021

Paroxysmal nonepileptic events (PNE) comprise of a variety of nonepileptic behaviors and are divided into various types. A more accurate diagnosis is possible by examining the video clip provided by the caregiver. In infants, physiologic PNE accounts for the majority of the PNE. It is important to exclude epilepsy, for which blood tests, electroencephalography, and imaging tests can facilitate differential diagnosis. Since most PNE have a benign progress, symptoms often improve with age and without special treatment. Therefore, it is important to reassure the caregivers after making an accurate diagnosis.

• Journal of Yeungnam Medical Science
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• v.38 no.4
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• pp.371-373
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• 2021

Serotonin syndrome (SS) is a potentially life-threatening condition that is caused by the administration of drugs that increase serotonergic activity in the central nervous system. We report a case of serotonin syndrome in a patient with chronic pain who was taking analgesic drugs. A 36-year-old female with chronic pain in the lower back and right buttock area had been taking tramadol hydrochloride 187.5 mg, acetaminophen 325 mg, pregabalin 150 mg, duloxetine 60 mg, and triazolam 0.25 mg daily for several months. After amitriptyline 10 mg was added to achieve better pain control, the patient developed SS, which was mistaken for psychogenic nonepileptic seizure. However, her symptoms completely disappeared after discontinuation of the drugs that were thought to trigger SS and subsequent hydration with normal saline. Various drugs that can increase serotonergic activity are being widely prescribed for patients with chronic pain. Clinicians should be aware of the potential for the occurrence of SS when prescribing pain medications to patients with chronic pain.

• Clinical and Experimental Pediatrics
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• v.64 no.6
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• pp.251-259
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• 2021

Psychogenic nonepileptic seizures (PNES) is a neuropsychiatric condition that causes a transient alteration of consciousness and loss of self-control. PNES, which occur in vulnerable individuals who often have experienced trauma and are precipitated by overwhelming circumstances, are a body's expression of a distressed mind, a cry for help. PNES are misunderstood, mistreated, under-recognized, and underdiagnosed. The mind-body dichotomy, an artificial divide between physical and mental health and brain disorders into neurology and psychiatry, contributes to undue delays in the diagnosis and treatment of PNES. One of the major barriers in the effective diagnosis and treatment of PNES is the dissonance caused by different illness perceptions between patients and providers. While patients are bewildered by their experiences of disabling attacks beyond their control or comprehension, providers consider PNES trivial because they are not epileptic seizures and are caused by psychological stress. The belief that patients with PNES are feigning or controlling their symptoms leads to negative attitudes of healthcare providers, which in turn lead to a failure to provide the support and respect that patients with PNES so desperately need and deserve. A biopsychosocial perspective and better understanding of the neurobiology of PNES may help bridge this great divide between brain and behavior and improve our interaction with patients, thereby improving prognosis. Knowledge of dysregulated stress hormones, autonomic nervous system dysfunction, and altered brain connectivity in PNES will better prepare providers to communicate with patients how intangible emotional stressors could cause tangible involuntary movements and altered awareness.

• Annals of Clinical Neurophysiology
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• v.9 no.2
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• pp.69-74
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• 2007

Electroencephalogram (EEG) is a representative diagnostic tool in epilepsy. However, there are several points of debate on the role of EEG in diagnosis and management of epilepsy. We suggest that EEG has some limitations for differential diagnosis from nonepileptic episodic diseases, classification of epilepsy, prediction of recurrence, and evaluation of treatment response. Interictal EEG cannot diagnose or exclude epilepsy because interictal epileptic discharge (IED) is frequently absent in epilepsy and can appear in nonepileptic conditions. Although EEG is helpful in classification of epilepsy, focal spikes in generalized epilepsy and secondary bilateral synchrony in localization related epilepsy cause interrater disagreement. It is controversial whether EEG predicts recurrence after the first seizure in adults. The predictive value of EEG in antiepileptic drug (AED) withdrawal is not absolute. The prognosis after AED withdrawal depends on epilepsy syndrome. Many studies could not confirm the value of EEG in assessing the treatment response. After all, epilepsy is clinically diagnosed and assessed. Interictal EEG alone does not provide decisive information and routine follow-up of EEG is not recommended.

• Clinical and Experimental Pediatrics
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• v.50 no.8
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• pp.726-731
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• 2007

This review describes the wide spectrum of paroxysmal events during sleep in infancy and childhood. The differential diagnosis between sleep-related non-epileptic paroxysmal events and epileptic seizures is difficult in special occasions. The nocturnal frontal lobe seizure and of the more common nonepileptic paroxysmal events during sleep are described. The main differentiating features characterizing parasomnias are: onset in early childhood, rare episodes of long duration, relatively lower frequency per night, absence of stereotypy, gradual disappearance of older age. Video-polysomnography is the gold standard to diagnosing and differentiating parasomnias from nocturnal frontal lobe seizures.

• Clinical and Experimental Pediatrics
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• v.51 no.1
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• pp.62-66
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• 2008

Purpose : In addition to epileptic seizures (ES), a variety of physiologic, organic and psychogenic disorders can manifest as paroxysmal behavioral events. Paroxysmal nonepileptic events (PNEs) are quite encountered in infants, young children, and adolescents. In a substantial proportion of cases, a careful history and examination will elucidate their nature. However, in other cases, it is necessary to differentiate PNEs from ES by video-electroencephalographic (EEG) monitoring. We report our experiences with PNEs in a group of children and adolescents who underwent video-EEG monitoring. Methods : From September, 2004 to June, 2006, one hundred thirty patients were monitored in the Pediatric Epilepsy Monitoring Units of Korea University Guro and Ansan hospitals. Their hospital charts were reviewed and video records of these events were analyzed. We observed all patients after video-EEG monitoring for more than 3 months. Results : Typical spells occurred during monitoring in 33 patients, not associated with a seizure pattern on EEG recordings. Two patients were diagnosed as frontal lobe epilepsy on basis of typical semiology and clinical characteristics, so 31 patients were documented to have PNEs finally. The mean age of patients was $7.2{\pm}5.8\;years$. The male to female ratio was 15 (48.4%) to 16 (51.6%). Among 31 patients, fifteen patients had associated disorders such as epilepsy, developmental delay, cerebral palsy, gastric ulcer, attention deficit hyperactivity disorder or depressive disorder. Somatoform disorder and factitious disorder was frequently seen in children more than 5 years old (P<0.05). Psychogenic disorder was more frequent in female (n=6) than in male (n=2) but there was no statistical significance (P>0.05). Conclusion : Our study suggests that video-EEG monitoring is an important diagnostic tool in the evaluation of paroxysmal behavioral events. With correct diagnosis of the PNEs, several unnecessary treatment could be avoided.