Psychogenic non-epileptic seizures in children and adolescents: Part I - Diagnostic formulations.
Psychogenic non-epileptic seizures in children and adolescents: Part I - Diagnostic formulations.
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DOI：
10.1177/1359104517732118
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发表时间：
2018-01
影响因子：
1.8
通讯作者：
Gill D
中科院分区：
文献类型：
--
作者：
Kozlowska K;Chudleigh C;Cruz C;Lim M;McClure G;Savage B;Shah U;Cook A;Scher S;Carrive P;Gill D
心因性非癫痫发作 (PNES) 是一个非特异性的总括类别，用于收集对情绪困扰、生理压力源和危险的一系列非典型神经生理反应。由于 PNES 模仿癫痫发作，因此患有 PNES 的儿童和青少年通常会到神经科医生或癫痫监测单位就诊。经过全面的神经学评估和 PNES 诊断后，患者被转诊至心理健康服务机构接受治疗。这项研究记录了诊断公式——关于可能的神经生理学机制的临床公式——是为 60 名连续患有 PNES 的儿童和青少年构建的，这些儿童和青少年被转介到我们的身心康复计划接受治疗。作为启发式框架，我们使用了 Janet 解离模型的当代改造：PNES 发生在神经系统不稳定的背景下，反映了认知情绪执行控制电路功能故障后预置运动程序的释放。使用这个框架，我们将 60 名患者分为六个不同的亚组：(1) 解离性 PNES (23/60；38%)，(2) 过度换气触发的解离性 PNES (32/60；53%)，(3) 表现为 PNES 的先天防御反应 (6/60；10%)，(4) 声带内收触发的 PNES (1/60；10%)，(4) 声带内收触发的 PNES (1/60；10%)。 2%），（5）由瓦尔萨尔瓦动作激活触发的 PNES（1/60；1.5%）和（6）由迷走神经反射激活触发的 PNES（2/60；3%）。正如配套文章中所述，这些诊断公式反过来又被用来告知我们向家庭提供的 PNES 解释，并设计临床干预措施以帮助儿童和青少年控制其 PNES。
Psychogenic non-epileptic seizures (PNES) are a nonspecific, umbrella category that is used to collect together a range of atypical neurophysiological responses to emotional distress, physiological stressors and danger. Because PNES mimic epileptic seizures, children and adolescents with PNES usually present to neurologists or to epilepsy monitoring units. After a comprehensive neurological evaluation and a diagnosis of PNES, the patient is referred to mental health services for treatment. This study documents the diagnostic formulations – the clinical formulations about the probable neurophysiological mechanisms – that were constructed for 60 consecutive children and adolescents with PNES who were referred to our Mind-Body Rehabilitation Programme for treatment. As a heuristic framework, we used a contemporary reworking of Janet’s dissociation model: PNES occur in the context of a destabilized neural system and reflect a release of prewired motor programmes following a functional failure in cognitive-emotional executive control circuitry. Using this framework, we clustered the 60 patients into six different subgroups: (1) dissociative PNES (23/60; 38%), (2) dissociative PNES triggered by hyperventilation (32/60; 53%), (3) innate defence responses presenting as PNES (6/60; 10%), (4) PNES triggered by vocal cord adduction (1/60; 2%), (5) PNES triggered by activation of the valsalva manoeuvre (1/60; 1.5%) and (6) PNES triggered by reflex activation of the vagus (2/60; 3%). As described in the companion article, these diagnostic formulations were used, in turn, both to inform the explanations of PNES that we gave to families and to design clinical interventions for helping the children and adolescents gain control of their PNES.
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影响因子：
6.4
作者：
Kozlowska K;Rampersad R;Cruz C;Shah U;Chudleigh C;Soe S;Gill D;Scher S;Carrive P
通讯作者：
Carrive P
DOI：
10.1073/pnas.1605044113
发表时间：
2016-08-30
影响因子：
11.1
作者：
Dum, Richard P.;Levinthal, David J.;Strick, Peter L.
通讯作者：
Strick, Peter L.
影响因子：
--
作者：
HOWARD, P;LEATHART, GL;SHARPEYSCHAFER, EP
通讯作者：
SHARPEYSCHAFER, EP
影响因子：
1.8
作者：
Kozlowska, Kasia;English, Margaret;Savage, Blanche
通讯作者：
Savage, Blanche
影响因子：
168.9
作者：
Fleming, Susannah;Thompson, Matthew;Stevens, Richard;Heneghan, Carl;Plueddemann, Annette;Maconochie, Ian;Tarassenko, Lionel;Mant, David
通讯作者：
Mant, David