Paroxysmal Nonepileptic Spells in Adolescence

Paroxysmal nonepileptic spells are often difficult to diagnose in pediatric patients owing to overlapping clinical features with epileptic seizures. A diagnosis of epilepsy is typically associated with pharmacologic and social sequelae, and an incorrect diagnosis can create an unnecessary burden highlighting the need for proper identification of paroxysmal nonepileptic spells. The adolescent population can present a further unique challenge compared with younger patients, and the common etiologies of nonepileptic events can often differ. These events can be seen in both psychiatric and nonpsychiatric conditions with the most common paroxysmal spell with a psychiatric basis being psychogenic nonepileptic seizures (PNES).1 The objective of this review is to identify common mimickers of epilepsy in adolescents, including migraine, syncope, movement disorders, sleep disorders, and psychologic disorders.