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

Yıl 2019, Cilt: 6 Sayı: 1, 33 - 36, 20.03.2019

Güray Koç , Semai Bek , Zeki Gökçil

Öz

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.

Anahtar Kelimeler

Diagnostic Delay, Non-Epileptic Seizures, Outcome, Seizure

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

Öz

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.  

Anahtar Kelimeler

Nonepileptik Nöbetler, Nöbet, Prognoz, Tanıda Gecikme

Kaynakça

• 1. Reuber M, Brown RJ. Understanding psychogenic nonepileptic seizures-Phenomenology, semiology and the Integrative Cognitive Model. Seizure. 2017;44:199-205.
• 2. Angus-Leppan H. Diagnosing epilepsy in neurology clinics: a prospective study. Seizure. 2008;17(5):431-6.
• 3. Chen-Block S, Abou-Khalil BW, Arain A, et al. Video-EEG results and clinical characteristics in patients with psychogenic nonepileptic spells: The effect of a coexistent epilepsy. Epilepsy Behav. 2016;62:62-5.
• 4. Martin R, Burneo JG, Prasad A, et al. Frequency of epilepsy in patients with psychogenic seizures monitored by video-EEG. Neurology. 2003;61(12):1791-2.
• 5. Dickinson P, Looper KJ. Psychogenic nonepileptic seizures: a current overview. Epilepsia. 2012;53(10):1679-89.
• 6. Kerr WT, Janio EA, Le JM, et al. Diagnostic delay in psychogenic seizures and the association with anti-seizure medication trials. Seizure. 2016;40:123-6.
• 7. Pretorius C. Barriers and facilitators to reaching a diagnosis of PNES from the patients' perspective: Preliminary findings. Seizure. 2016;38:1-6.
• 8. Jones SG, TJ OB, Adams SJ, et al. Clinical characteristics and outcome in patients with psychogenic nonepileptic seizures. Psychosom Med. 2010;72(5):487-97.
• 9. Perez DL, LaFrance WC, Jr. Nonepileptic seizures: an updated review. CNS Spectr. 2016;21(3):239-46.
• 10. Asadi-Pooya AA, Tinker J. Delay in diagnosis of psychogenic nonepileptic seizures in adults: A post hoc study. Epilepsy Behav. 2017;75:143-5.
• 11. Asadi-Pooya AA, Sperling MR. Epidemiology of psychogenic nonepileptic seizures. Epilepsy Behav. 2015;46:60-5.
• 12. Reuber M, Fernandez G, Bauer J, Helmstaedter C, Elger CE. Diagnostic delay in psychogenic nonepileptic seizures. Neurology. 2002;58(3):493-5.
• 13. Asadi-Pooya AA, Ziyaee F. Outcome of patients with psychogenic nonepileptic seizures with limited resources: A longitudinal study. Seizure. 2018;59:1-4.
• 14. Tolchin B, Dworetzky BA, Baslet G. Long-term adherence with psychiatric treatment among patients with psychogenic nonepileptic seizures. Epilepsia. 2018;59(1):18-22.
• 15. Duncan R, Anderson J, Cullen B, Meldrum S. Predictors of 6-month and 3-year outcomes after psychological intervention for psychogenic non epileptic seizures. Seizure. 2016;36:22-6.
• 16. Baroni G, Martins WA, Piccinini V, et al. Neuropsychiatric features of the coexistence of epilepsy and psychogenic nonepileptic seizures. J Psychosom Res. 2018;111:83-8.