Suggestive Seizure Induction technique in a pediatric PNES population related to neurocognitive and psychological profile: a pilot study.

Objective: To investigate seizures induction techniques response in a pediatric population affected by psychogenic non epileptic seizures (PNES) and the relationship between neurocognitive and psychological profiles. Methods: We recruited patients referred to our Unit who received a diagnosis of clinically established PNES in the last year. Enrolled patients underwent video-EEG recording that included a seizures induction standardized protocol:bitemporal compression, verbal suggestion, diapason stimulation,saline buffer,hyperpnea and intermittent light stimulation (ILS).Patients also carried out neuropsychiatric evaluation. Results: The sample consisted of 12 patients (9 females and 3 males) aged between 12 and 17 years old (mean 15.08).Seizure phenotype was mostly generalized tonic-clonic seizures with loss of consciousness (7/12 patients, 58,3%).7 patients (GROUP A, 58.3%) presented seizures during induction tests and seizures were inducted by two techniques in three of them. In particular,bitemporal compression activated seizures in a patient (8.3%),verbal suggestion in 4 patients(33,3%),saline buffer in 5 patients (41,6%), ILS in 2 patients.Patients who did not present seizures (GROUP B, 41,7%) during the test reported somatic complaints in each technique (headache, paresthesias, visual impairment, chest pain). Neuropsychological tests showed a mild intellectual disability in one patient (8,3%), borderline intellectual functioning in two patients (16,6%) and 4 patients (33,3%) received diagnosis of Learning Disorder.Regarding cognitive profiles, GROUP A had a mean IQ of 85 (versus a mean of 94 in GROUP B) and lower verbal comprehension index compared to perceptual reasoning index (mean VCI=90 vs mean PRI=102,28).Psychopatological evaluation showed higher scores in the Dissociation Questionnaire in GROUP A compared to GROUP B. Conclusions: Results showed a possible role of lower verbal ability and a higher dissociation proneness in young PNES patients who respond to suggestion techniques.