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

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.