TY - JOUR T1 - Coexistence of Epilepsy and Psychogenic Nonepileptic Seizures; a Faceless Menace Underlying Pseudointractability TT - Epilepsi ve Psikojenik Nonepileptik Nöbet Birlikteliği; Psödodirencin Altında Yatan Görünmeyen Tehlike AU - Koç, Güray AU - Bek, Semai AU - Gökçil, Zeki PY - 2019 DA - March JF - Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi JO - MMJ PB - Mugla Sitki Kocman University WT - DergiPark SN - 2148-8118 SP - 33 EP - 36 VL - 6 IS - 1 LA - en AB - Psychogenicnonepileptic seizures (PNES) may be evaluated as epileptic seizures (ES).Moreover, PNES may be accompanied by ES and might be the cause of resistance toantiepileptic drug (AED) in patients with ES which can be defined aspseudoresistance. We aimed to evaluate the rate of PNES and comorbidity of PNESand ES in our database as well as evaluating the prognosis in these patients.We retrospectively evaluated the records of all patients who were admitted tothe epilepsy center between January 1, 2007, and March 31, 2015. Medical recordreview included outpatient clinic notes, neurological findings, video-EEGmonitorization reports, home videos of patients, routine EEG reports, brainimages, and follow-up of patients. A total of 4247 patients were evaluated and114 of these patients had PNES. There were 65patients with PNES only and 49 patients with PNES/ES. Patients withPNES/ES had a longer duration of diagnosis than patients with PNES(p<0.001). Psychiatric treatment was recommended to all, 105 (92.1%) of themhad accepted to go under treatment but only 16 (18%) of them took benefit fromtreatment. Once the patient had epilepsy, all spells were usually considered asepileptic seizures and dosage and number of AED treatment was increased becauseit was considered as drug resistant epilepsy. We found that suspicion aboutPNES in patients with intractable epilepsy is helpful to make the rightdiagnosis and treatment. The clinician who is interested in patients withepilepsy should always keep PNES in mind. KW - Diagnostic Delay KW - Non-Epileptic Seizures KW - Outcome KW - Seizure N2 - Psikojeniknonepileptik nöbetler (PNEN), epileptik nöbetler (EN) olarakdeğerlendirilebilir. Bundan da fazla olarak PNEN, EN’ye eşlik edebilir veepilepsi hastalarında psödodirenç olarak tanımlayabileceğimiz antiepileptikilaca (AEİ) direncin nedeni olabilir. Bu çalışmada PNEN ve PNEN ile ENbirlikteliğini ve bu hastalarda prognozu değerlendirmeyi amaçladık. 1 Ocak 2007ve 1 Mart 2016 tarihleri arasında epilepsi merkezine gelen hastalarındosyalarını retrospektif olarak inceledik. Hastaların poliklinik notlarını,nörolojik bulguları, video-EEG monitörizasyonu raporlarını, hastaların evvideolarını, rutin EEG kayıtlarını ve takiplerini değerlendirdik. Toplamda 4247hasta incelendi ve 114 hastada PNEN saptandı. Sadece PNEN olan 65 hasta,PNEN/EN birlikteliği olan 49 hasta vardı. PNEN/EN birlikteliği olan hastalardatanı koyma süresi, sadece PNEN olanlara göre daha uzundu (p<0.001).Psikiyatrik tedavi bütün hastalara önerildi, 105 (%92.1) hasta tedaviyi kabuletti, ancak sadece 16 (%15.2) hasta tedaviden fayda gördü. Eğer hasta epilepsihastası ise genellikle bütün ataklar EN olarak kabul ediliyor ve AEİ dozu vesayısı, hasta ilaca dirençli kabul edilerek artırılıyor. Biz dirençliepilepsili hastalarda PNEN’den şüphe edilmesinin doğru tanı koymada ve doğrutedavide yardımcı olacağını bulduk. Epilepsi ile ilgilenen klinisyenlerin PNEN’i hepakıllarının bir köşesinde tutması önemlidir. CR - 1. Reuber M, Brown RJ. 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