OBJECTIVES: We aimed to study the frequency, age and gender distribution of paroxysmal non-epileptic events (PNEs) in children referred to epilepsy clinic. We also evaluated the therapeutic implications of correct diagnosis and co-existence of true epilepsy and behavioural co-morbidities in this population.

METHODS: All new patients below 18 years age attending the Paediatric epilepsy clinic of a tertiary hospital with history of paroxysmal events characterized by abrupt changes in consciousness or behaviour or movement of limbs, body or eyes were included. Patients were assessed based on detailed description of events, sometimes aided by recorded videos. If the diagnosis was not confirmed by this preliminary evaluation, further investigations were advised.

RESULT: Two hundred new patients presenting with paroxysmal events were enrolled over six months. After diagnoses, 19% of these children had PNEs, 80% had epileptic events, and 1% remained undiagnosed. Common events seen were physiological or organic in patients less than five years of age and psychogenic events in older children. Syncope was more common in adolescents. There was no statistically significant gender predilection for different PNEs. Thirty four percent of patients with PNEs were on anti-epileptic drugs (AEDs).  After confirming non-epileptic attacks, only 2.6% patients needed AEDs for coexisting epilepsy which was statistically significant (p<0.001) change in treatment.

SIGNIFICANCE: Epilepsy mimics are common in children and are often misdiagnosed causing undue stress to both the child and parents. Correct diagnosis leads to drastic change in management like withdrawal of drugs, commencing new treatment if needed and appropriate referrals.