Current approach to differential diagnosis of epileptic seizures and pseudo-seizures

Yıl 2011, , 330 - 334, 01.09.2011

Adalet Arıkanoğlu

https://doi.org/10.5799/ahinjs.01.2011.03.0067

Öz

Epileptic seizure is the emergence of various transient signs and symptoms resulting from abnormal excessive electrical discharges and synchronous activity. Pseudoseizure can be defined as clinical events that resemble epileptic attacks which are not associated with central nervous system dysfunction. It is difficult to differentiate between pseudoseizures and epileptic seizures. Treatment of pseudoseizures like epileptic seizures causes the use of unnecessary and inappropriate antiepileptic medications. Patients refer to emergency polyclinics again and again, and examinations are repeated needlessly. Therefore, their life quality deteriorates and this situation causes economic burden at the same time. In this article, we investigate the clinical features, EEG findings, biological parameters and autonomic neural system tests that should be looked out for in order to differentiate between epileptic seizures and pseudoseizures in conjunction with the latest literature studies.

Anahtar Kelimeler

-

Epileptik nöbet ve psödonöbetlerin ayırıcı tanısına güncel yaklaşım

Öz

Epileptik nöbet; anormal aşırı elektriksel deşarjlara ve eşzamanlı nöronal aktiviteye bağlı çeşitli bulgu ve işaretlerin geçici olarak ortaya çıkmasıdır. Psödonöbet; santral sinir sistemi disfonksiyonu ile ilişkisi olmayan, epileptik ataklara benzeyen klinik durumlar olarak tanımlanabilir. Psödonöbetlerin epileptik nöbetlerden ayırımı zordur. Psödonöbetlerin epileptik nöbet gibi tedavi edilmesi gereksiz ve uygunsuz antiepileptik kullanımına neden olmaktadır. Hastalar defalarca acil polikliniklere başvururlar, gereksiz yere tetkikler tekrarlanır; dolayısı ile yaşam kalitelerinde bozulmanın yanısıra ekonomik olarak da yük haline gelirler. Biz bu yazıda epileptik nöbetlerle psödonöbetlerin ayırımında dikkat edilmesi gereken klinik özelikler, EEG bulguları ve biyolojik parametreleri, otonom sinir sistemi testlerini son literatür çalışmaları eşliğinde inceledik.

Anahtar Kelimeler

Epilepsi, psödonöbet, ayırıcı tanı

Kaynakça

• Engel J.Jr. ILAE Commission Report. A proposed diagnos- tic scheme for people withepileptic seizures and epilepsy: Report of the ILAE Task Force on Classification and Termi- nology. Epilepsia 2001;42(7): 796 -803.
• Yeni SN. Epilepsi Epidemiyolojisi. Turkiye Klinikleri J Neu- rol-Special Topics 2008;1(2):9-16.
• Kaplan Y. Menopoz Döneminde Başlayan Epilepsi: 5 Olgu- nun Sunumu. J Neurol Sci [Turk] 2007; 13;349-53.
• Gilroy J. Epilepsy in Basic Neurology. Third Edition, Mc Graw-Hill Companies 2000; 85-121.
• Bradley W, Daroff R, Fenichel G, Iankovic I. Neurology in clinical practice. The neurological disorders. The Epilep- sies. Fourth Ed. Butterworth-Heienemann 2004; 1953-92.
• Fowle AJ, Binnie CD. Uses and abuses of the EEG in epi- lepsy. Epilepsia 2000;41(1): 10-8.
• Tezer Fİ, Uluşahin A, Saygı S. De Nevo psychogenic nonepi- leptic seizures after epilepsy surgey. J Neurologica 2007; 24(2): 170-7.
• Ertuğrul S, Aydın M. Epileptik olmayan paroksismal bozuk- luklar. J Curr Pediatrics 2005; 3(2):90-4.
• Dworetzky BA, Bubrick EJ, Szaflarski JP. Nonepileptic psy- chogenic status: Markedly prolonged psychogenic nonepi- leptic seizure. Epilepsy&Behavior 2010; 19(1):65-8.
• Chabolla DR, Krahn LE, So EL, Rummans TA. Psycho- genic Nonepileptic Seizures. Mayo Clin. Proc. 1996; 71 (5): 493-500.
• Tütüncü R, Türkçapar MH. Pseudoepileptik Nöbet Tanısı Alan Konversiyon Bozukluğu Hastalarının Bir Yıllık İzlem Sonuçları. Klinik Psikiyatri 2003; 6(1):76-9.
• Abubakr A, Kablinger A, Caldito G. Psychogenic seizures: clinical features and psychological analysis. Epilepsy Be- hav 2003; 4 (3): 241-5.
• Roelofs K, Naring GW, Moene FC,Hoogduin CA. The question of symptom lateralization in conversion disorder. J Psychosom Res 2000; 49(1):21-5.
• Lesser RP. Psychogenic seizures. Neurology 1996; 46(12): 1499-507.
• Avbersek A, Sisodiya S. Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures? J Neurol Neorosurg Psychiatry 2010;81(7):719-25.
• Varlı K. Yalancı Epileptik Nöbetler. Klinik Psikiyatri 1999; 2(2): 101-4.
• Chung SS, Gerber P, Kirlin KA. Ictal eye closure is a reli- able indicator for psychogenic nonepileptic seizures. Neu- rology 2006;66:1730e1.
• Sen A, Scott C, Sisodiya SM. Stertorous breathing is a reliably identified signthat helps in the differentiation of epileptic from psychogenic non-epileptic convulsions: an audit. Epilepsy Res 2007;77:62e4.
• Oliva M, Pattison C, Carino J, et al. The diagnostic value of oral lacerations and incontinence during convulsive ‘sei- zures.’ Epilepsia 2008;49:962e7.
• Siket MS, Merchant RC. Psychogenic seizures: A review and description of pitfalls in their acute diagnosis and man- agement in the emergency department. Emerg Med Clin North Am. 2011;29(1):73-81.
• Nousiainen U, Suomalainen T, Mervaala E. Clinical benefıts of scalp EEG studies in intractable seizure disorders. Acta Neurol Scand 1992; 85(2): 181-6.
• Binnie CD. Eleetroencephalography. A Textbook of Epilepsy’de, Laidlaw J, Richens A, Oxley J (eds), third edition, Churchill Livingstone Ine, printed in Great Britain 1988; (8) : 236-306.
• Theodore WH. Pseudoseizures: differential diagnosis. J Neuropsychiatry Clin Neurosci 1989; 1 (1): 67-9.
• Kapur J, Pillai A, Henry T. Psychogenic Elaboration of Sim- ple Partial Seizures. Epilepsia 1995; 36(11): 1126-30.
• Özen Ş, Özbulut Ö, Altındağ A ve ark. Acil serviste kon- versiyon bozukluğu tanısı konan hastaların sosyodemog- rafik özellikleri, stres faktörleri, I. ve II. eksen eştanılar. Türkiye’de Psikiyatri 2000; 2(1): 87-96.
• Mülayim S, Yıldırım G. Epileptik Nöbet ve Psödonö- betlerden Sonra Serum Prolaktin Düzeyleri. Epilepsi 2008;14(3):176-80.
• LeBlanc J, Ducharme MB, Thompson M. Study on the correlation of the autonomic nerveus system response to a stressor of high discomfort with personality traits. Physiol Behav 2004; 82(6):647-52.
• Baksis P, Roelofs K, Kuyk J, Edelbroek PM, Swinkels WA, Spinhoven P. Trauma, stres, and preconscious threat pro- cessing in patients with psychogenic nonepileptic seizures. Epilepsia 2009; 50(10): 1001-11.
• Müngen B, Berilgen MS, Arıkanoğlu A. Autonomic ner- vous system functions in interictal and postictal periods of nonepileptic psychogenic seizures and its comparison with epileptic seizures. Seizure 2010;19(3):269-73.
• Pakalnis A, Drake ME J, Phillips B. Neuropsychiatric aspects of psychogenic status epilepticus. Neurology 1991;41(12):1104-6.