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Journals / Çocuk Dergisi / 2025 / Cilt: 25 Sayı: 4

Paroxysmal Non-Epileptic Events in Pediatric Patients: A Three-Year Experience from a Tertiary Center

Emek Uyur(University of Health Sciences, Zeynep Kamil Maternity and Children’s Diseases Training and Research Hospital)0000-0001-6071-6375
Nilüfer Eldeş Hacıfazlıoğlu(University of Health Sciences, Zeynep Kamil Maternity and Children’s Diseases Training and Research Hospital)0000-0001-8828-8587
Derya Güder(University of Health Sciences, Zeynep Kamil Maternity and Children’s Diseases Training and Research Hospital)0000-0002-1867-6477
Bilgihan Bıkmazer(University of Health Sciences, Zeynep Kamil Maternity and Children’s Diseases Training and Research Hospital)0000-0003-1974-8951
Azize Büyükkoç(University of Health Sciences, Zeynep Kamil Maternity and Children’s Diseases Training and Research Hospital)0000-0002-2105-162X
Rabia Gönül Sezer Yamanel(University of Health Sciences, Zeynep Kamil Maternity and Children’s Diseases Training and Research Hospital)0000-0002-9447-3583
Pages
270–278
Publication Date
2026-02-12
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Identifying typical patterns in outpatient settings may improve diagnostic accuracy and help prevent unnecessary tests and treatments.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Objectives: Paroxysmal non-epileptic events (PNEs) are common in the pediatric age group.
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Key Findings & Data:Materials and methods: The data of 512 patients who were referred to the Pediatric Neurology outpatient clinic for the differential diagnosis of epilepsy and subsequently diagnosed with PNEs between January 2022 and December 2024 were retrospectively evaluated.
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Conclusion & Impact:Identifying typical patterns in outpatient settings may improve diagnostic accuracy and help prevent unnecessary tests and treatments.
🔬Design:Araştırma Makalesi
📍Scope:2022 Verileri
⚙️Variables:Nonepileptic event · Paroxysmal event · Childhood

Abstract

Objectives: Paroxysmal non-epileptic events (PNEs) are common in the pediatric age group. PNEs can generally be differentiated by their distinct symptomatology and the absence of epileptiform activity on electroencephalography (EEG). This study aimed to examine the types and distribution of PNEs among children referred to a tertiary pediatric neurology center. Materials and methods: The data of 512 patients who were referred to the Pediatric Neurology outpatient clinic for the differential diagnosis of epilepsy and subsequently diagnosed with PNEs between January 2022 and December 2024 were retrospectively evaluated. Results: Of the 512 patients, 255 were male (49.8%). The most common diagnosis was syncope (38.3%), followed by breath-holding spells (27.9%) and tic disorders (9.6%). Less frequent conditions included night terrors (4.9%), shuddering attacks (4.7%), benign sleep myoclonus (3.7%), gratification disorder (3.5%), and psychogenic non-epileptic seizures (2.5%). Additional rare diagnoses, each <2%, were also identified. Tic disorder was significantly more common in males (p < 0.001), whereas syncope was more frequent in females (p = 0.002). Home video recordings were available in 20.9% of patients at the initial visit. During the follow-up, additional recordings were obtained in all cases, except for syncope. Video-EEG monitoring was required for diagnostic confirmation in only 4.5% of cases. Conclusion: Distinguishing PNEs from epileptic seizures can be difficult; however, a detailed clinical history and examination are essential for an accurate diagnosis. Breath-holding spells were more common in early childhood, whereas syncope and tic disorders predominated in older children. Home video recordings were helpful in supporting the diagnosis and often reduced the need for video-EEG. Identifying typical patterns in outpatient settings may improve diagnostic accuracy and help prevent unnecessary tests and treatments.

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Cite This Article

Uyur, E., Hacıfazlıoğlu, N. E., Güder, D., Bıkmazer, B., Büyükkoç, A., Yamanel, R. G. S. (2026). Paroxysmal Non-Epileptic Events in Pediatric Patients: A Three-Year Experience from a Tertiary Center. Çocuk Dergisi, Cilt: 25 Sayı: 4, 270–278. https://doi.org/10.26650/jchild.2025.1767986

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References (37)

  1. Metrick ME, Ritter FJ, Gates JR, Jacobs MP, Skare SS, Loewenson RB. Nonepileptic events in childhood. Epilepsia. 1991;32(3):322–8. doi: 10.1111/j.1528-1157.1991.tb04658.x. PMID: 2044495. google scholar
  2. Kaki A, Almutairi M, Alharbi R, Alotaibi A, Alwadei A, Bamogaddam F, et al. Paroxysmal nonepileptic events in children and adolescents admitted to the epilepsy monitoring unit: a retrospective study. Brain Disord. 2023;100082. doi:10.1016/j.dscb.2023.100082. google scholar
  3. Lagorio I, Brunelli L, Striano P. Paroxysmal nonepileptic events in children: a video gallery and a guide for differential diagnosis. Neurol Clin Pract. 2022;12(4):320–7. doi:10.1212/CPJ.0000000000001171. PMID: 36382123. google scholar
  4. Benbadis SR. The differential diagnosis of epilepsy: a critical review. Epilepsy Behav. 2009;15(1):15–21. doi:10.1016/j.yebeh.2009.02.024. PMID:19236946. google scholar
  5. Sankhyan N. Non-epileptic paroxysmal events mimicking seizures. Indian J Pediatr. 2014;81(9):898–902. doi:10.1007/s12098-014-1531-3. PMID:25062544. google scholar
  6. Park EG, Lee J, Lee BL, Lee M, Lee J. Paroxysmal nonepileptic events in pediatric patients. Epilepsy Behav. 2015;48:83–7. doi:10.1016/j.yebeh.2015.05.029. PMID:26074345. google scholar
  7. Sharma A. Seizures and epilepsy in children. Indian J Pediatr. 2013;80(11):925–35. doi:10.1007/s12098-013-1173-x. PMID:24048876. google scholar
  8. Leibetseder A, Eisermann M, LaFrance WC Jr, Nobili L, von Oertzen TJ. How to distinguish seizures from non-epileptic manifestations. Epileptic Disord. 2020;22(6):716– 38. doi:10.1684/epd.2020.1234. PMID:33399092. google scholar
  9. Jung SY, Kang JW. Is it really a seizure? The challenge of paroxysmal nonepileptic events in young infants. Clin Exp Pediatr. 2021;64(8):384–92. doi:10.3345/cep.2020.00451. PMID:32972054. google scholar
  10. Huang L, Wang Y, Liu L, Tang H, Zhang M, Ma S, et al. Home videos as a cost-effective tool for the diagnosis of paroxysmal events in infants: prospective study. JMIR Mhealth Uhealth. 2019;7(9):e11229. doi:10.2196/11229. PMID: 31516128. google scholar
  11. Burr T, Modiano Y, Raichur P, Barton C, Sah J, Farber D, et al. Predictive value of video alone in diagnosis of epileptic vs paroxysmal nonepileptic events in children. Epilepsy Behav. 2022;134:108863. doi:10.1016/j.yebeh.2022.108863. PMID:35930919. google scholar
  12. Karakas C, Ferreira LD, Haneef Z. Use of video alone for differentiation of epileptic seizures from non-epileptic spells: a systematic review and meta-analysis. Seizure. 2023;110:177–87. doi:10.1016/j.seizure.2023.06.022. PMID:37406461. google scholar
  13. Thabit MN, Sadek AA, Motawe ES, Ali RAE, Mohamed MM. Non-epileptic paroxysmal events in paediatric patients: a single tertiary centre study in Egypt. Seizure. 2021;86:123– 8. doi:10.1016/j.seizure.2021.02.004. PMID:33607445. google scholar
  14. Tatlı B, Güler S. Non-epileptic paroxysmal events in childhood. Turk Pediatri Ars. 2017 Jun;52(2):59–65. doi:10.5152/TurkPediatriArs.2017.4588. PMID: 28747835. PMCID: PMC5509124. google scholar
  15. Luat AF, Kamat D, Sivaswamy L. Paroxysmal nonepileptic events in infancy, childhood, and adolescence. Pediatr Ann. 2015;44(2):e18–23. doi:10.3928/00904481-20150203-07. PMID:25658214. google scholar
  16. Sporer KA, Johnson NJ. Detailed analysis of prehospital interventions in medical priority dispatch system determinants. West J Emerg Med. 2011;12(1):19–29. PMID: 21691468; PMCID: PMC3088370. google scholar
  17. Heggstad N, Hafstrom M. Seizure-like events leading to hospital referrals in infants: a retrospective population-based study. Acta Paediatr. 2021 Feb;110(2):584-93. doi:10.1111/ apa.15467. PMID: 32648969. google scholar
  18. Sadleir LG, Scheffer IE. Epilepsy syndromes in infancy and childhood. In: Dulac O, Lassonde M, Sarnat HB, editors. Handbook of Clinical Neurology. Vol. 111, 3rd series, Pediatric Neurology Part I. Amsterdam: Elsevier; 2012. p.437-64. google scholar
  19. Yavuz P, Gunbey C, Karahan S, Topcu M, Turanli G, Yalnizoglu D. Non-epileptic paroxysmal events at pediatric video-electroencephalography monitoring unit over a 15-year period. Seizure. 2023;108:89–95. doi:10.1016/j.seizure.2023.04.016. PMID:37119582. google scholar
  20. Patel H, Scott E, Dunn D, Garg B. Nonepileptic seizures in children. Epilepsia. 2007;48(11):2086–92. doi:10.1111/j.1528-1167.2007.01200.x. PMID:17645540. google scholar
  21. Gowda VK, Amoghimath R, Benakappa N, Shivappa SK. Spectrum of nonepileptic paroxysmal events in children from Southern India. J Neurosci Rural Pract. 2019;10(4):608–12. doi:10.1055/s-0039-3399472. PMID:31831979. google scholar
  22. Kutluay E, Selwa L, Minecan D, Edwards J, Beydoun A. Nonepileptic paroxysmal events in a pediatric population. Epilepsy Behav. 2010;17(2):272–5. doi:10.1016/j.yebeh.2009.12.020. PMID:20093099. google scholar
  23. Chen L, Pestana Knight EM, Tuxhorn I, Shahid A, Lüders HO. Paroxysmal non-epileptic events in infants and toddlers: a phenomenologic analysis. Psychiatry Clin Neurosci. 2015;69(6):351–9. doi:10.1111/pcn.12277. PMID: 25297526 google scholar
  24. Dhiman V, Sinha S, Rawat VS, Vijaysagar KJ, Thippeswamy H, Srinath S, et al. Children with psychogenic non-epileptic seizures (PNES): a detailed semiologic analysis and modified new classification. Brain Dev. 2014;36(4):287–93. doi:10.1016/j.braindev.2013.05.002. PMID:23756292. google scholar
  25. 25 Zhu W, Bian X, Lv J. Advances in diagnosis, management, and long-term outcomes of pediatric vasovagal syncope: a comprehensive review. Front Cardiovasc Med. 2025;12:1481749. doi:10.3389/fcvm.2025.1481749. PMID: 40351605 google scholar
  26. Pecora R, Trani L, Guido C, Spalice A, Versacci P, Sideli L, et al. Psychopathological correlates and psychosocial functioning in children and adolescents with syncope: a systematic review. Clin Neuropsychiatry. 2024;21(5):358–75. doi:10.36131/ cnfioritieditore20240502. PMID:39540075. google scholar
  27. Alboni P, Messop AC, Lauri A, Furlan R. Are women really more affected by vasovagal syncope than men? J Cardiovasc Med (Hagerstown). 2021;22(2):69–78. doi:10.2459/ JCM.0000000000001009. PMID:32925389. google scholar
  28. Ashrafi MR, Shajari H, Salajegheh N, Kiani A. Breath-holding spells: an analysis of 43 cases. Iran J Child Neurol. 2009;1(2):17–20. doi:10.22037/ijcn.v1i2.981. google scholar
  29. Wolf DS, Singer HS. Pediatric movement disorders: an update. Curr Opin Neurol. 2008;21(4):491–6. doi:10.1097/WCO.0b013e328307bf1c. PMID:18607212. google scholar
  30. Kim SH, Kim H, Lim BC, et al. Paroxysmal nonepileptic events in pediatric patients confirmed by long-term video-EEG monitoring: single tertiary center review of 143 patients. Epilepsy Behav. 2012;24(3):336–40. doi:10.1016/j.yebeh.2012.03.022. PMID: 22579031 google scholar
  31. Szabo L, Siegler Z, Zubek L, et al. A detailed semiologic analysis of childhood psychogenic nonepileptic seizures. Epilepsia. 2012;53(3):565–70. doi:10.1111/ j.1528-1167.2012.03404.x. PMID: 22332748 google scholar
  32. Madaan P, Gulati S, Chakrabarty B, Sapra S, Sagar R, Mohammad A, et al. Clinical spectrum of psychogenic non-epileptic seizures in children: an observational study. Seizure. 2018;59:60–6. doi:10.1016/j.seizure.2018.04.024. PMID:29754012. google scholar
  33. Operto FF, Coppola G, Mazza R, Pastorino GMG, Campanozzi S, Margari L, et al. Psychogenic nonepileptic seizures in pediatric population: a review. Brain Behav. 2019;9(12):e01406. doi:10.1002/brb3.1406. PMID:31568694. google scholar
  34. Yılmaz Ü, Serdaroğlu A, Gürkaş E, Hirfanoğlu T, Cansu A. Childhood paroxysmal nonepileptic events. Epilepsy Behav. 2013;27(1):124–9. doi:10.1016/j.yebeh.2012.12.028. PMID:23416282. google scholar
  35. Chiba Y, Phillips OR, Takenoshita S, Ollila HM, Hallmayer JF, Nishino S, et al. Genetic and demographic predisposing factors associated with pediatric sleepwalking in the Philadelphia Neurodevelopmental Cohort. J Neurol Sci. 2021 Nov 15;430:119997. doi:10.1016/j.jns.2021.119997. PMID: 34525335. google scholar
  36. Salmina C, Taddeo I, Falesi M, Weber P, Bianchetti MG, Ramelli GP. Paroxysmal tonic upgaze in normal children: a case series and a review of the literature. Eur J Paediatr Neurol. 2012 Nov;16(6):683–7. doi:10.1016/j.ejpn.2012.04.004. PMID: 22591809. google scholar
  37. Blumkin L, Leshinsky-Silver E, Michelson M, Zerem A, Kivity S, Lev D, Lerman-Sagie T. Paroxysmal tonic upward gaze as a presentation of de-novo mutations in CACNA1A. Eur J Paediatr Neurol. 2015 May;19(3):292–7. doi:10.1016/j.ejpn.2014.12.018. PMID: 25596066. google scholar