Psychogenic non-epileptic seizures: aetiology, diagnosis and management
Psychogenic non-epileptic seizures: aetiology, diagnosis and management
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心因性非癫痫发作：病因、诊断和治疗
DOI：
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
M. Reuber
中科院分区：
文献类型：
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作者：
M. Oto;M. Reuber
心因性非癫痫性发作（PNES）在痛苦、残疾、收入损失和医源性伤害方面对大多数患者产生重大影响。四分之三的PNES患者最初被误诊为癫痫并接受治疗。误诊使患者暴露于多种医源性伤害，并使他们无法获得心理治疗。在大多数情况下，病人的病史（和目击者的叙述）应该提醒临床医生对PNES的可能诊断。由于这种诊断可能会受到患者的抵制，并且可能涉及“未诊断”癫痫，因此典型癫痫发作的视频脑电图记录通常是有帮助的。PNES的潜在原因是多种多样的：一个结合易感性、促发性和持续性因素的模型是概念化其病因的有效方法。治疗的第一步应该是限制医源性伤害。有证据表明心理治疗是有效的。
SUMMARY Psychogenic non-epileptic seizures (PNES) have a significant impact on most patients in terms of distress, disability, loss of income and iatrogenic harm. Three-quarters of patients with PNES are initially misdiagnosed and treated for epilepsy. Misdiagnosis exposes patients to multiple iatrogenic harms and prevents them from accessing psychological treatment. In most cases, the patient’s history (and witness accounts) should alert clinicians to the likely diagnosis of PNES. Since this diagnosis may be resisted by patients and may involve ‘un-diagnosing’ epilepsy, video-electroencephalogram recording of typical seizures is often helpful. The underlying causes of PNES are diverse: a model combining predisposing, precipitating and perpetuating factors is a useful way of conceptualising their aetiology. The initial step of treatment should be to limit iatrogenic harm. There is some evidence for the effectiveness of psychotherapy.