Does the teddy bear sign predict psychogenic nonepileptic seizures?

This study evaluated whether adults and older teenagers who bring toy stuffed animals to an epilepsy monitoring unit (EMU), i.e., the "teddy bear sign," were more likely to be diagnosed to have psychogenic nonepileptic seizures (PNES) than to have epilepsy. We prospectively evaluated 335 patients, aged 15. years and older, admitted to our EMU over a 19-month period, assessing age at seizure onset, duration of seizures, gender, seizure diagnosis, presence of intellectual disabilities, presence of psychiatric illness, and possession of a toy stuffed animal in the EMU. Among all ages, patients who brought toy stuffed animals were not more likely to have PNES or both PNES and epilepsy than to have epilepsy alone. For those 18 and over, there was a significant difference but only after adjusting for all other patient characteristics, and absolute differences were small. Patients 18 and older with stuffed animals had a 3.21 (95% confidence interval = 1.58, 8.90) times greater odds of being diagnosed to have PNES or both PNES and epilepsy than to have epilepsy alone after adjusting for other patient characteristics (p = 0.022). We conclude that patient possession of toy stuffed animals in the EMU is not a reliable sign of PNES.