Coexistence of Epilepsy and Psychogenic Nonepileptic Seizures; a Faceless Menace Underlying Pseudointractability

Year 2019, Volume: 6 Issue: 1, 33 - 36, 20.03.2019

Güray Koç , Semai Bek , Zeki Gökçil

Abstract

Psychogenic
nonepileptic seizures (PNES) may be evaluated as epileptic seizures (ES).
Moreover, PNES may be accompanied by ES and might be the cause of resistance to
antiepileptic drug (AED) in patients with ES which can be defined as
pseudoresistance. We aimed to evaluate the rate of PNES and comorbidity of PNES
and ES in our database as well as evaluating the prognosis in these patients.
We retrospectively evaluated the records of all patients who were admitted to
the epilepsy center between January 1, 2007, and March 31, 2015. Medical record
review included outpatient clinic notes, neurological findings, video-EEG
monitorization reports, home videos of patients, routine EEG reports, brain
images, and follow-up of patients. A total of 4247 patients were evaluated and
114 of these patients had PNES. There were 65  
patients with PNES only and 49 patients with PNES/ES. Patients with
PNES/ES had a longer duration of diagnosis than patients with PNES
(p<0.001). Psychiatric treatment was recommended to all, 105 (92.1%) of them
had accepted to go under treatment but only 16 (18%) of them took benefit from
treatment. Once the patient had epilepsy, all spells were usually considered as
epileptic seizures and dosage and number of AED treatment was increased because
it was considered as drug resistant epilepsy. We found that suspicion about
PNES in patients with intractable epilepsy is helpful to make the right
diagnosis and treatment. The clinician who is interested in patients with
epilepsy should always keep PNES in mind.

Keywords

Diagnostic Delay, Non-Epileptic Seizures, Outcome, Seizure

Epilepsi ve Psikojenik Nonepileptik Nöbet Birlikteliği; Psödodirencin Altında Yatan Görünmeyen Tehlike

Abstract

Psikojenik
nonepileptik nöbetler (PNEN), epileptik nöbetler (EN) olarak
değerlendirilebilir. Bundan da fazla olarak PNEN, EN’ye eşlik edebilir ve
epilepsi hastalarında psödodirenç olarak tanımlayabileceğimiz antiepileptik
ilaca (AEİ) direncin nedeni olabilir. Bu çalışmada PNEN ve PNEN ile EN
birlikteliğini ve bu hastalarda prognozu değerlendirmeyi amaçladık. 1 Ocak 2007
ve 1 Mart 2016 tarihleri arasında epilepsi merkezine gelen hastaların
dosyalarını retrospektif olarak inceledik. Hastaların poliklinik notlarını,
nörolojik bulguları, video-EEG monitörizasyonu raporlarını, hastaların ev
videolarını, rutin EEG kayıtlarını ve takiplerini değerlendirdik. Toplamda 4247
hasta incelendi ve 114 hastada PNEN saptandı. Sadece PNEN olan 65 hasta,
PNEN/EN birlikteliği olan 49 hasta vardı. PNEN/EN birlikteliği olan hastalarda
tanı koyma süresi, sadece PNEN olanlara göre daha uzundu (p<0.001).
Psikiyatrik tedavi bütün hastalara önerildi, 105 (%92.1) hasta tedaviyi kabul
etti, ancak sadece 16 (%15.2) hasta tedaviden fayda gördü. Eğer hasta epilepsi
hastası ise genellikle bütün ataklar EN olarak kabul ediliyor ve AEİ dozu ve
sayısı, hasta ilaca dirençli kabul edilerek artırılıyor. Biz dirençli
epilepsili hastalarda PNEN’den şüphe edilmesinin doğru tanı koymada ve doğru
tedavide yardımcı olacağını bulduk. Epilepsi ile  ilgilenen klinisyenlerin PNEN’i hep
akıllarının bir köşesinde tutması önemlidir.  

Keywords

Nonepileptik Nöbetler, Nöbet, Prognoz, Tanıda Gecikme

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