The effects of familial risk and parental resolution on parenting a child with mild intellectual disability

The current study investigated the manner by which family risk moderates the links between parental state of resolution with a child's diagnosis and both parent–child interaction and parental stress. The sample included 72 families with 4–7-year-old children (M = 5.53, SD = 0.73) diagnosed with mild intellectual disability. Parents reported on their resolution state and parental stress, and parent–child interactions were videotaped and analyzed. Results indicated that in families where mothers or fathers were unresolved rather than resolved, mother–child interactions were less positive only in the context of high family risk. The father–child interaction was not found to be affected by family risk and parental resolution. Interestingly, mothers in low family risk situations who were resolved reported the lowest level of parental stress, suggesting a “double buffer” effect, whereas fathers with high family risk who were unresolved experienced the highest levels of parental stress, suggesting a “double risk” effect.     

Is ADHD severity in adults associated with the lifetime prevalence of comorbid depressive episodes and anxiety disorders?

PurposeThe objective of the present study was to examine the association between ADHD severity and the lifetime prevalence of comorbid depressive episodes and anxiety disorders in adults with ADHD.Subjects/materials and methodsAnalyses were based on data of the Conner's Adult ADHD Rating Scale (CAARS) and a parent study examining the epidemiology of adult ADHD in 17 GP practices in Budapest, Hungary. Subjects between 18 and 60 years were included in the screening phase (n = 3529). Out of 279 positively screened subjects 161 participated in a clinical interview and completed the CAARS to confirm the diagnosis. We applied four diagnostic criteria: “DSM-IV”; “No-onset” (DSM-IV criteria without the specific requirement for onset); “Symptoms-only” (DSM-IV symptom criterion only); and “Reduced symptoms-only” (DSM-IV symptom criterion with a reduced threshold for symptom count). The MINI PLUS 5.0 was used to assess psychiatric comorbidity.ResultsADHD severity, as measured by the CAARS ADHD Index, showed a significant positive association with the prevalence of comorbid depressive episodes in all but the “ADHD_No-onset” group (“DSM-IV”: F[1.23] = 8.39, P = 0.0081; “No-onset”: F(1.27) = 0.97, P = 0.3346; “Symptoms-only”: F[1.55] = 30.79, P < 0.0001; “Reduced symptoms-only”: F(1.62) = 26.69, P < 0.0001).Discussion and conclusionResults indicate that ADHD symptom severity increases in association with lifetime comorbidity with depression.     

Agreement in quality of life assessment between adolescents with intellectual disability and their parents

Intellectual disability affects different aspects of functioning and quality of life, as well as the ability to independently assess the quality of life itself. The paper examines the agreement in the quality of life assessments made by adolescents with intellectual disability and their parents compared with assessments made by adolescents without intellectual disability and their parents.Participants included 67 adolescents with intellectual disability and the same number of their parents. Control group consisted of 122 typically developed adolescents and an equal number of their parents. In order to assess the quality of life we used The PedsQL 4.0 Generic Core Scale questionnaire, for adolescents aged between 13 and 18 and their parents. Agreement in assessing quality of life between adolescents and parents was analyzed using t-test, Kappa Statistics and Pearson correlation.The agreement between adolescents with intellectual disability and their parents was found to be acceptable (k = 0.43), while the agreement between adolescent from control group and their parents was judged to be good (k = 0.84). Correlations between adolescents with intellectual disability and their parents varied across subscales from weak (r = 0.31) on the physical health subscale to moderate (r = 0.56) on the social subscale. Adolescents with intellectual disability were less satisfied with their social functioning. The highest agreement, as well as the lowest means value was found on the social agreement scale.Assessment of the quality of life by both adolescents and their parents provides a comprehensive insight into functioning and different aspects of quality of life in these adolescents.     

A randomised controlled trial of two early intervention programs for young children with autism: Centre-based with parent program and home-based

This study compares outcomes of early intervention programs for young children with autism; an individualised home-based program (HB), a small group centre-based program for children combined with a parent training and support group (CB) and a non-treatment comparison group (WL). Outcome measures of interest include social and communication skill development in children, quality of life and stress for parents. Eligible (diagnosed ASD, preschool age) participants were randomised into 2 groups HB (n = 28) and CB (n = 28). A WL (n = 29) comparison group was also recruited. HB and CB groups had 12-month programs. Pre and post assessments were conducted using formal and informal measures. Children in the CB group improved significantly more than HB and WL groups on some social and communication measures. On parent measures outcomes varied with CB group parents making the most gains in perception of competence and quality of life. The small group centre-based program combined with parent program resulted in the best most cost effective outcomes for children and families however this is not an option for all. The CB program did not suit some children and families. The heterogeneity of the autism population indicates that a range of intervention options is necessary to meet the needs of children with autism and their families.     

“Muscle Pics”, a new body-checking behavior in muscle dysmorphia?

Background and aimsThe internalization of ideal hypermuscular body and pro-muscularity media's influence have shown their importance in muscle dysmorphia development. The aim of the current study is to have a better understanding of links between specific body checking behaviors and muscle dysmorphia in social network context.MethodsIn total, 342 students practicing weightlifting at the university gym in Bordeaux answered to a survey with sociodemographic information and body checking symptoms including taking specific selfies of muscles and muscularity “Muscle Pics” and the MDDI (Muscle Dysmorphic Disorder Inventory).ResultsMuscle dysmorphia was prevalent in 18.7% of our population (64 students). We observed that muscle dysmorphia was correlated to “Muscle Pics”, “Follow-up”, “Message”, “Selfie”, and gym mirror checking with significant results (P < 0.01). Also, « Muscle Pics » were linked to APEDs use, pro-muscularity websites, fitness model comparison and gym mirror checking (P < 0.01). For muscle dysmorphia, “Muscle Pics” have strong predictive results (OR = 5.10, P = 0.000) and (OR = 4.08, P = 0.000) for adjusted. “Follow up” (OR = 4.76, P = 0.000) and (OR = 3.83, P = 0.000) for adjusted, “Muscle Pics Selfie” (OR = 11.20, P = 0.000) and (OR = 11.55, P = 0.000) for adjusted, “Muscle Pics Message” (OR = 4.49, P = 0.001) and (OR = 5.78, P = 0.001) for adjusted.Conclusion“Muscle Pics” showed several links with muscle dysmorphia for global score “drive for size”, “functional impairment” but not for “appearance intolerance” dimension. Pro-muscularity websites, fitness model comparisons and gym mirror checking are linked to muscle dysmorphia and “Muscle Pics”. Future research on “Muscle Pics” will help to provide a better understanding of muscle dysmorphia and its link with pro-muscularity influence websites.     

Évaluation de la charge mentale des téléopérateurs dans un centre d’appel tunisien

BackgroundThe call centers are a growing business sector around the world and currently in Tunisia. However, this occupational activity proves to be a source of many constraints, which can cause multiple complaints among teleoperators.ObjectivesTo evaluate the level of stress at work in a group of teleoperators and identify the factors associated with it.MethodsThis is a cross-sectional study of a random sample of 266 teleoperators from a call center in Sousse (Tunisia). The survey was based on a questionary that included social and occupational data, the assessment of work stress through the Karasek questionnaire, the study of the balance of effort and reward using the Siegrist questionnaire and the evaluation of Nonspecific psychic suffering by the GHQ12 questionnaire.ResultsA total of 264 teleoperators participated in the study, representing a participation rate of 99.2%. Our population was predominant by female (57,6%), with an average age of 29,6 ± 10,1 years. A psychiatric history was found in 4,5% of cases. The stress prevalence calculated using the “effort/rewards” imbalance model was 16,7% while it was 25,8% according to the Karasek model. Psychic suffering was noted in 61,7% of employees. The “effort/reward” imbalance was significantly associated with having parents in charge (p = 0,04). While work stress correlated with tenure (p = 0,032) and history of chronic disease (p = 0,014), psychic suffering was only correlated with gender (p = 0,024).ConclusionThe data of this study, underlines the interest of the improvement of the working conditions in the reduction of stress at work at the teleoperators. These measures will improve not only the satisfaction, the work experience and the quality of life of these employees, but also their services.     

Perceived need for restrictions on activity for children with epilepsy

BackgroundChildren and youth with epilepsy have long been subjected to excessive restrictions on extracurricular activities due to concerns over risk of injury. Over time physicians and medical regulatory associations have liberalized the advice given for people with epilepsy to promote independence, self-esteem and general health benefits of physical activity. Current evidence suggests that few restrictions are needed for children with epilepsy beyond water-related precautions and avoidance of very high-risk activities. However, more stringent restrictions on daily activities may be imposed by caregivers. This study was aimed at exploring current perceptions of parents regarding restrictions on activity for children with epilepsy and the child’s perspective on restrictions related to the diagnosis.MethodsA self-administered questionnaire was offered to a sample of parent-child dyads of children/youth with epilepsy attending summer camp for children with epilepsy age 8–18 years. A 10-item validated HARCES Parent Scale of Childhood Epilepsy was completed by the parent/guardian and a modified-HARCES completed by the child. The primary objective was to assess the degree of restrictions placed on children with epilepsy from the perspective of child and parent assessed independently. Agreement of perceived restrictions between parent-child dyads was also determined.Results21 parent/guardian-child pairs were recruited with mean age of children/youth 12.7 years (range 9–16 years). Total HARCES scores for parents and guardians ranged from 11–26 (x = 16.5; SD 4.9) while total scores for children with epilepsy similarly ranged from 10–25 (x = 15.2; SD 4.9). There were no differences in total parent scores when analyzed by child's age (< 13 or > 13 years), gender, age of seizure onset, seizure frequency or seizure type. Total HARCES scores showed no agreement between parent and child pairs with correlation of 0.2798 (95% CI − 0.173–0.635).ConclusionsChildren and youth with epilepsy often face activity restrictions based on fear of perceived risk of injury. This small sample shows evidence that even more permissive parents and his/her children still feel limited by such restrictions. Parents and children do not perceive these restrictions in the same way despite similar education by physicians highlighting an important secondary role of epilepsy camps in targeting misperceptions and educating families on appropriate precautions.     

“You can do it!”: The role of parental encouragement of bravery in child anxiety treatment

Individual cognitive-behavioral therapy (CBT) provides anxious youth with skills and experiences to increase “brave” behavior in the face of feared situations. This study addresses whether parental encouragement of bravery during an anxiety provoking and potentially avoidable naturalistic speech task (a) differs between parents of youth (ages 9–13) with anxiety disorders (N = 47) and parents of healthy non-anxious controls (N = 20); (b) influences response to treatment; and (c) changes during treatment for anxious youth randomized to receive CBT (N = 30) or Child-Centered Therapy (CCT; a non-directive active comparison treatment; N = 17). Parent–child dyads were videotaped during a discussion of whether or not the child should complete an optional speech task. Parents of anxious youth showed less encouragement of bravery than parents of controls. Encouragement of bravery increased from pre- to post-treatment for youth who received CBT but not CCT, and pre-treatment encouragement of bravery predicted a better response to treatment, particularly for youth receiving CBT.     

Trends in the prevalence of childhood disability: Analysis of data from the national disability registry of Taiwan, 2000–2011

Childhood disability is not uncommon, but data at the national level are limited, especially those on the changes in the prevalence over time. On the basis of the Disabled Welfare Act, Taiwan began to certify disabled residents and provide various services in 1980. All the cases receiving services are registered, and the registry provides a rare opportunity for studying childhood disability at the national level. Using the data from 2000 to 2011, we calculated the age-specific prevalence of all disability combined and assessed the changes over time. We also calculated the prevalence rate and the proportion in all disabilities combined for each disability category and assessed the trends. As certification before 3 years old is generally discouraged by the government, we limited analyses to children between 3 and 17 years old. We found that the registered cases ranged from 49,242 to 61,717 from 2000 to 2011 and that intellectual disability (ID), had been the leading category all through the years. The proportion of autism spectrum disorders (ASD) had been increasing rapidly and become the third leading disability in 2011. The prevalence of all disabilities combined increased constantly from 9.98/1000 to 15.41/1000 (p < 0.01), and increases were generally observed every year in all age groups (p < 0.01). The increase could largely be attributable to the increases in ID and ASD, while the increasing trends were also significant in “multiple disabilities,” “speech or language impairment,” and “other disabilities listed by the Department of Health” (p < 0.01 for all the five categories). An increase with age in the prevalence of all disabilities combined could be observed all through the years (p < 0.01 in all calendar years). We concluded that the prevalence of childhood disability has been increasing in Taiwan, with ID contributing the most cases and ASD as an emerging problem. However, the increase of prevalence cannot be attributed entirely to the increase in the occurrence of cases, and an increase in the proportion of cases registered was an more important factor, which may be in turn attributable to a better service of the related agencies, lower discrimination against the patients, higher awareness of the disorder, and more willingness of the guardians to register.     

Intraduodenal levodopa-carbidopa intestinal gel infusion improves both motor performance and quality of life in advanced Parkinson’s disease

We report the efficacy and adverse effect profile of intraduodenal levodopa-carbidopa intestinal gel (LCIG) infusion from patients treated in a single Australian movement disorder centre. We conducted an open-label, 12 month prospective study of treatment with LCIG in patients with advanced Parkinson’s disease in a single tertiary referral hospital unit specialising in movement disorders. Patients with levodopa-responsive, advanced Parkinson’s disease with motor fluctuations despite optimal pharmacological treatment were enrolled and underwent a 16 hour daily infusion of LCIG for 12 months. Fifteen participants completed the trial. The mean (±standard deviation) improvement in Unified Parkinson’s Disease Rating Scale part III was 37 ± 11%, mean daily “off” period reduced from 6.3 ± 2 to 1.9 ± 2 hours, total daily “on” time increased from 10.2 ± 3 to 13.7 ± 2 hours, “on” period without dyskinesia increased from 4.5 ± 3 to 7.5 ± 5 hours, and 39-item Parkinson’s Disease Questionnaire Summary Index score improved by 32.5 ± 35%. The most common adverse event was reversible peripheral neuropathy secondary to vitamin B12 ± B6 deficiency (40%), local tube problems (40%), and impulse control disorder (ICD) (27%). No patient had stoma bleeding or peritonitis. All patients with ICD had a past psychiatric diagnosis of depression with or without anxiety and a higher daily levodopa intake at 6 and 12 months of LCIG infusion. Intraduodenal LCIG improves motor performance, quality of life and daily “on” period. Prior to and during duodenal LCIG infusion, clinicians should monitor for peripheral neuropathy and vitamin B12 and B6 deficiency, as supplementation can reverse peripheral neuropathy. This trial is registered at Clinicaltrials.gov as CT00335153.     

Efficacy and tolerability of Hypericum perforatum in major depressive disorder in comparison with selective serotonin reuptake inhibitors: A meta-analysis

Hypericum perforatum is a medicinal plant with established antidepressant properties. The aim of this meta-analysis was to compare the efficacy and tolerability of this antidepressant with selective serotonin reuptake inhibitors (SSRIs) as a group of standard antidepressants. For this purpose, Pubmed, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were searched for studies comparing efficacy and/or tolerability of Hypericum with SSRIs in the management of major depressive disorder (MDD). The search terms were: “Hypericum” or “St. John's wort” and “fluoxetine”, “paroxetine”, “citalopram”, “serteraline”, “escitalopram”, or “fluvoxamine”. Data were collected from 1966 to 2008 (up to June). “Clinical response”, “remission”, “mean reduction in Hamilton Rating Scale for Depression (HAMD) score from baseline”, “total adverse events”, and “withdrawals due to adverse events” were the key outcomes of interest.Thirteen randomized placebo controlled clinical trials met our criteria and were included. Comparison of SSRIs with placebo yielded a significant relative risk (RR) of 1.22 (95% confidence interval: 1.03–1.45, P = 0.02) for clinical response (n = 4), a non significant RR of 0.96 (95% CI: 0.71–1.29, P = 0.76) for remission (n = 4), and a significant effect size [weighted mean difference (wmd+)] of 1.33 (95% CI: 1.15–1.51, P < 0.0001) for mean reduction in HAMD score from baseline (n = 3).Comparison of Hypericum with SSRIs yielded a non significant relative risk (RR) of 0.99 (95% confidence interval: 0.91–1.08, P = 0.83) for clinical response, a non significant RR of 1.1 (95% CI: 0.90–1.35, P = 0.35) for remission, and a non-significant wmd+ of 0.32 (95% CI: ? 1.28–0.64, P = 0.52) for mean reduction in HAMD score from baseline, a non significant RR of 0.85 (95% CI: 0.7–1.04, P = 0.11) for any adverse events, and a significant RR of 0.53 (95% CI: 0.35–0.82, P = 0.004) for withdrawals due to adverse events.Hypericum does not differ from SSRIs according to efficacy and adverse events in MDD. Lower withdrawal from study due to adverse events by Hypericum is an advantage in management of MDD.     

Children with new onset seizures: A prospective study of parent variables,child behavior problems,and seizure occurrence

ObjectiveParent variables (stigma, mood, unmet needs for information and support, and worry) are associated with behavioral difficulties in children with seizures; however, it is not known how this relationship is influenced by additional seizures. This study followed children (ages 4–14 years) and their parents over a 24-month period (with data collected at baseline and 6, 12, and 24 months) and investigated the effect of an additional seizure on the relationship between parenting variables and child behavior difficulties.MethodsThe sample was parents of 196 children (104 girls and 92 boys) with a first seizure within the past 6 weeks. Child mean age at baseline was 8 years, 3 months (SD 3 years). Data were analyzed using t-tests, chi-square tests, and repeated measures analyses of covariance.ResultsRelationships between parent variables, additional seizures, and child behavior problems were consistent across time. Several associations between parent variables and child behavior problems were stronger in the additional seizure group than in the no additional seizure group.ConclusionsFindings suggest that interventions that assist families to respond constructively to the reactions of others regarding their child's seizure condition and to address their needs for information and support could help families of children with continuing seizures to have an improved quality of life.     

Clinical,electrodiagnostic, and outcome correlation in ALS patients in Thailand

Introduction: The diagnosis of amyotrophic lateral sclerosis (ALS) requires both clinical and electrodiagnostic (EDx) data. The correlation between the two may aid in outcome prognostication.Methods: Retrospective review of patients with ALS in tow tertiary hospitals in Thailand.Results: Data from 25 ALS patients out of 38 patients with motor neuron disease was reviewed. Male was predominant with mean age of onset of 60.1 ± 10.7 years old. The average time from onset to diagnosis was 19.8 ± 21.5 months. Upper limb onset was the most common. Nerve conduction study showed lower median and ulnar compound muscle action potential amplitudes than tibial and peroneal ones. Electromyography (EMG) showed 40% of patients have EMG abnormalities in asymptomatic limbs. Neurophysiological evidence of “split hand” was frequent in upper limb phenotype. Sensory studies were abnormal in 16.3%. Most patients were classified in mRS 1 and 2 (73.9%) at the time of diagnosis which was statistically significant among subgroups. Bulbar and distal upper limb subtypes had a better prognosis. 5.4% of patients used mechanical ventilator; all in bulbar subgroup.Conclusion: In our ALS patients, upper limb onset was the most common. Time of presentation varied among phenotypes. Extensive EDx can contribute to early diagnosis in asymptomatic limb and improve diagnostic certainty. Abnormal sensory study was also common. EDx data clearly correlates with clinical phenomena and prognosis. At the time of diagnosis, ALSFRS was in moderate range and most patients had moderate disability.     

Role of parental occupation in autism spectrum disorder diagnosis and severity

Some have suggested that parents of children with autism spectrum disorder (ASD) may present with less recognizable autistic-like phenotypic characteristics, leading them to highly systemizing occupations. Using secondary analysis of data from two previous studies of children with ASD, we tested associations between parental occupations and ASD diagnosis and the association of parental occupational characteristics on ASD severity. We found that fathers in healthcare (P < 0.01) and finance (P = 0.03) were more likely to have children with ASD. Additionally, joint effects of parental technical occupations were associated with communication (P < 0.01) and social impairment (P = 0.04). These results support that a “broader phenotype” and possible assortative mating in adults with autistic-like characteristics might contribute to intergenerational transmission and having offspring with greater ASD severity.     

Quality of life and employment status are correlated with antiepileptic monotherapy versus polytherapy and not with use of “newer” versus “classic” drugs: Results of the “Compliant 2006” survey in 907 patients

“Classic” and “newer” antiepileptic drugs (AEDs) were compared in an epidemiological survey regarding patient's acceptance of AEDs, quality of life (QoL), and employment. Data from 907 outpatients, 45.9% female (mean age: 44.8 ± 17.9 years), were evaluated by 90 neurologists in private practices, who were also involved in a non-interventional study by Sanofi–Aventis Deutschland GmbH, regarding medication, seizure type, illness duration, employment, patients’ acceptance of AEDs (4-point scale where 1 = very good), and QoL (6-point scale where 1 = very good). Among the patients, 69.7% were on monotherapy, 25.4% were taking two AEDs, and 4.9% were taking more than two AEDs. Patient's acceptance of AEDs (mean ± SD = 1.65 ± 0.62) and QoL (2.34 ± 0.89) were “good.” Among patients aged 18–65 years, 68.6% were employed. QoL and acceptance were lower with polytherapy. Older age and polytherapy were associated with lower probability of employment. No differences emerged between “classic” and “newer” AED monotherapy. Polytherapy-associated lower QoL could be due to severity of illness or adverse effects of treatment.     

Affective dimensions as a diagnostic tool for bipolar disorder in first psychotic episodes

ObjectiveTo examine the predictive diagnostic value of affective symptomatology in a first-episode psychosis (FEP) sample with 5 years’ follow-up.MethodAffective dimensions (depressive, manic, activation, dysphoric) were measured at baseline and 5 years in 112 FEP patients based on a factor structure analysis using the Young Mania Rating Scale and Hamilton Depression Rating Scale. Patients were classified as having a diagnosis of bipolar disorder at baseline (BDi), bipolar disorder at 5 years (BDf), or “other psychosis”. The ability of affective dimensions to discriminate between these diagnostic groups and to predict a bipolar disorder diagnosis was analysed.ResultsManic dimension score was higher in BDi vs. BDf, and both groups had higher manic and activation scores vs. “other psychosis”. Activation dimension predicted a bipolar diagnosis at 5 years (odds ratio = 1.383; 95% confidence interval, 1.205–1.587; P = 0.000), and showed high levels of sensitivity (86.2%), specificity (71.7%), positive (57.8%) and negative predictive value (90.5%). Absence of the manic dimension and presence of the depressive dimension were both significant predictors of an early misdiagnosis.ConclusionThe activation dimension is a diagnostic predictor for bipolar disorder in FEP. The manic dimension contributes to a bipolar diagnosis and its absence can lead to early misdiagnosis.     

Cognitive modifiability of children with developmental disabilities: A multicentre study using Feuerstein's Instrumental Enrichment—Basic program

The study aimed at exploring the effectiveness of cognitive intervention with the new “Instrumental Enrichment Basic” program (IE-basic), based on Feuerstein's theory of structural cognitive modifiability that contends that a child's cognitive functioning can be significantly modified through mediated learning intervention. The IE-basic progam is aimed at enhancing domain-general cognitive functioning in a number of areas (systematic perception, self-regulation abilities, conceptual vocabulary, planning, decoding emotions and social relations) as well as transferring learnt principles to daily life domains. Participants were children with DCD, CP, intellectual impairment of genetic origin, autistic spectrum disorder, ADHD or other learning disorders, with a mental age of 5–7 years, from Canada, Chile, Belgium, Italy and Israel. Children in the experimental groups (N = 104) received 27–90 h of the program during 30–45 weeks; the comparison groups (N = 72) received general occupational and sensory–motor therapy. Analysis of the pre- to post-test gain scores demonstrated significant (p < 0.05) advantage of experimental over comparison groups in three WISC-R subtests (“Similarities”, “Picture Completion”, “Picture Arrangement”) and Raven Coloured Matrices. Effect sizes ranged from 0.3 to 0.52. Results suggest that it is possible to improve cognitive functioning of children with developmental disability. No advantage was found for children with specific aetiology. Greater cognitive gains were demonstrated by children who received the program in an educational context where all teachers were committed to the principles of mediated learning.     

Outcome of psychogenic nonepileptic seizures (PNES) in children: A 2-year follow-up study

ObjectiveThe objective of this study was to determine the outcome of psychogenic nonepileptic seizures (PNES) in children seen at a level 4 epilepsy center.MethodsWe retrospectively analyzed patients under the age of 18 years who were diagnosed with PNES based on evaluation in the epilepsy monitoring unit and had a follow-up of at least 2 years postdiagnosis. Remission of events was noted at 6 months, 12 months, and 24 months of follow-up, and patient and disease variables affecting outcome were studied.ResultsNinety patients met inclusion criteria (58 females; mean age: 14.03 ± 3.3 years). Thirty-two out of ninety (36%) patients had early (within 6 months) and sustained remission (until 2 years of follow-up) of their events (“favorable outcome”), while 30/90 patients (33%) never achieved remission during the study period (“unfavorable outcome”). The factors that were associated with “unfavorable outcome” included the presence of comorbid epilepsy [12/30 (40%) vs 0/32, p < 0.0001] and prolonged duration of symptoms before establishment of the diagnosis (median 365 days vs 60 days, p < 0.0001). Patient's age, gender, frequency of events, the presence of major psychosocial stressors, and comorbid psychiatric conditions had no significant impact on the disease outcome.ConclusionsAbout a third of children with PNES achieve early and sustained remission of symptoms, while another third continue to manifest seizure-like events until at least two years after the diagnosis. The presence of comorbid epilepsy and prolonged duration of PNES are associated with a poor two-year outcome. Early suspicion and diagnosis of PNES, especially in patients with epilepsy, is essential.     

What do epileptologists recommend about discontinuing antiepileptic drugs for a second time in children?

ObjectiveThere is a broad consensus that antiepileptic drugs (AEDs) may be withdrawn after two years of seizure freedom for most children with epilepsy. If seizures recur and are, again, completely controlled with AEDs, little is known about discontinuing a second time. We surveyed American and Canadian pediatric epileptologists to understand their current practice.MethodsIn 2014, a survey was sent via e-mail to 193 pediatric epileptologists to learn about AED discontinuation practices in children. The survey asked direct questions about practice and posed five “real-life” cases where the decision to discontinue might be difficult. Participants were identified through membership lists of several US and Canadian epilepsy organizations.ResultsThere were 94 (49%) completed surveys. Sixty-three participants had ≥ 10 years in practice (“more experienced”: mean 23 ± 9 years), and 31 had < 10 years (“less experienced”: mean 6 ± 2). Overall, 62% recommended AED discontinuation for the first time after 2–3 years of seizure freedom, and 61% recommended discontinuation for the second time after 2–3 years. Fifty-six percent of “more experienced” clinicians required a longer seizure-free period prior to a second discontinuation (p < 0.001) compared with 26% of “less experienced” clinicians (p = ns). Overall, most participants suggested an AED taper duration of 2–6 months for the first and second attempts, 52% and 68%, respectively. Both groups wean AEDs more slowly during the second attempt (p < 0.001). There was only 40–60% agreement among participants to discontinue AEDs in four of the cases.ConclusionNearly half (46%) of pediatric epileptologists require a longer seizure-free period the second time they attempt to discontinue AEDs compared with the first attempt and wean down AEDs somewhat more slowly. Although a variety of factors influence decision-making, there was a high level of disagreement to discontinue AEDs a second time in “real-life” cases.