Fifteen-minute consultation: when is a seizure not a seizure? Part 2, the older child

Paroxysmal non-epileptic events (PNEs) refer to episodic changes in behaviour, sensation or consciousness that lead to unusual movements, which may resemble epileptic seizures, but are not, due to excessive neuronal firing in the cerebral cortex. A significant proportion of patients seen in epilepsy clinics do not actually have epilepsy. Therefore, it is paramount for clinicians to be able to recognise these transient non-epileptic events in order to avoid unnecessary antiepileptic treatments and to provide appropriate management as required. These PNEs can be observed within the context of a neurological disorder such as migraine or with no direct neurological basis such as simple tics. In this review, we have described common PNEs presenting in school-age children and adolescents alongside the clinical approach to differentiate them from epileptic seizures. PNEs occurring in infancy and younger children have been covered in our first review of this series.