Diagnostic delay in psychogenic seizures and the association with anti-seizure medication trials
Diagnostic delay in psychogenic seizures and the association with anti-seizure medication trials
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DOI：
10.1016/j.seizure.2016.06.015
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发表时间：
2016-08-01
影响因子：
3
通讯作者：
Stern, John M.
中科院分区：
文献类型：
--
作者：
Kerr, Wesley T.;Janio, Emily A.;Stern, John M.
目的：心因性非癫痫发作（PNES）从首次发作到确诊的平均延迟时间超过7年。这一拖延的原因尚不清楚。我们假设，在癫痫发作频率开始后的抗癫痫药物（ASM）可能有助于较长的延迟，但这样的反应的频率还没有得到很好的established.Methods：从发病到诊断的时间，用药史和相关的癫痫发作频率从297例连续PNES诊断使用视频脑电图监测的医疗记录。指数回归模型的药物试验和响应诊断delay.Results的效果：平均诊断延迟为8.4年（最小1天，最大52年）。基于10对log（10）延迟平均值的指数模型，稳健的平均诊断延迟为2.8年（95% CI：2.2-3.5年）。每个ASM试验增加了稳健的平均延迟指数至少三分之一的一年（Wald t = 3.6，p = 0.004）。对ASM试验的反应并没有显著改变诊断延迟（Wald t =-0.9，p = 0.38）。结论：虽然在这些PNES患者中观察到对ASM的反应，但反应的存在与更长的时间直到最终诊断无关。相反，尝试ASM的数量与诊断延迟时间较长相关，这表明尽管缺乏应答，但ASM试验仍在继续。这些数据支持癫痫发作患者在两次药物试验失败后应转诊至癫痫护理中心的指南。(C)2016年英国癫痫协会。由爱思唯尔有限公司出版。保留所有权利。
Purpose: The average delay from first seizure to diagnosis of psychogenic non-epileptic seizures (PNES) is over 7 years. The reason for this delay is not well understood. We hypothesized that a perceived decrease in seizure frequency after starting an anti-seizure medication (ASM) may contribute to longer delays, but the frequency of such a response has not been well established.Methods: Time from onset to diagnosis, medication history and associated seizure frequency was acquired from the medical records of 297 consecutive patients with PNES diagnosed using video-electroencephalographic monitoring. Exponential regression was used to model the effect of medication trials and response on diagnostic delay.Results: Mean diagnostic delay was 8.4 years (min 1 day, max 52 years). The robust average diagnostic delay was 2.8 years (95% CI: 2.2-3.5 years) based on an exponential model as 10 to the mean of log(10) delay. Each ASM trial increased the robust average delay exponentially by at least one third of a year (Wald t = 3.6, p = 0.004). Response to ASM trials did not significantly change diagnostic delay (Wald t = -0.9, p = 0.38).Conclusion: Although a response to ASMs was observed commonly in these patients with PNES, the presence of a response was not associated with longer time until definitive diagnosis. Instead, the number of ASMs tried was associated with a longer delay until diagnosis, suggesting that ASM trials were continued despite lack of response. These data support the guideline that patients with seizures should be referred to epilepsy care centers after failure of two medication trials. (C) 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.