The relationship between epileptic and non-epileptic seizures in childhood

This paper illustrates the difficulty in distinguishing non-epileptic and epileptic attacks in children who have abnormal epileptiform interictal EEG. We describe our own experience with long-term video EEG monitoring (VEEG), including the recording technique and objective and subjective monitoring difficulties specific to children. The usefulness of VEEG was demonstrated in cases where non-epileptic and epileptic seizures occurred frequently, however VEEG was not useful when seizures were infrequent. In practice it is recommended to combine neurological methods to differentiate non-epileptic and epileptic seizures and to use VEEG more frequently, especially prior to initiating potentially toxic anti-epileptic pharmacotherapy. This is particularly important in children with autism, mental retardation, other neurological dysfunctions and those with refractory epilepsies. Timely diagnosis of non-epileptic seizures with initiation of appropriate therapy will certainly improve the final outcome. Clinical assessment and developmental follow up continue to be crucial steps because the child’s growth and development can impact the clinical manifestation of the disorder.

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