The respiratory control of carbon dioxide in children and adolescents referred for treatment of psychogenic non-epileptic seizures.
The respiratory control of carbon dioxide in children and adolescents referred for treatment of psychogenic non-epileptic seizures.
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DOI：
10.1007/s00787-017-0976-0
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发表时间：
2017-10
影响因子：
6.4
通讯作者：
Carrive P
中科院分区：
文献类型：
--
作者：
Kozlowska K;Rampersad R;Cruz C;Shah U;Chudleigh C;Soe S;Gill D;Scher S;Carrive P
心因性非癫痫性发作（PNES）是儿科神经病学和精神病学的常见问题，最好理解为对威胁的非典型反应。威胁通过调节唤醒、呼吸和运动准备的增加来激活身体采取行动。在以前的研究中，一系列的心脏，内分泌，脑为基础的，注意力偏差，和行为的措施已被用来证明增加觉醒，警惕性，和运动准备与PNES患者。目前的研究使用呼吸措施来评估呼吸系统的运动准备和CO2的呼吸调节。记录了60名接受PNES治疗的儿童和青少年以及50名对照组的临床评估期间的基线呼吸率和常规视频脑电图过度通气部分期间的动脉CO2水平。患者显示基线呼吸频率升高[t（78）= 3.34，p = .001]，36/52（69%）患者[vs. 11/28（39%）对照组]高于第75百分位数（χ 2 = 6.7343; df = 1; p = .009）。28例（47%）患者[vs. 4/50（8%）对照组]显示出偏斜的过度通气-激发曲线-基线PCO 2 <36 mmHg，谷值PCO 2 ≤ 20 mmHg，或CO2调节恢复信号困难15分钟后最终PCO 2 <36 mmHg（χ 2 = 19.77; df = 1; p < .001）。PNES儿童和青少年处于准备就绪状态，其特征是高唤醒加上呼吸运动系统激活，通气增加，以及从稳态范围向下移动的换气过度-挑战曲线。针对唤醒、降低呼吸频率、使通气和动脉CO2正常化的呼吸干预可能有助于患者改变脑-体状态并避免PNES发作。本文的在线版本（doi：10.1007/s 00787 -017-0976-0）包含补充材料，可供授权用户使用。
Psychogenic non-epileptic seizures (PNES) are a common problem in paediatric neurology and psychiatry that can best be understood as atypical responses to threat. Threats activate the body for action by mediating increases in arousal, respiration, and motor readiness. In previous studies, a range of cardiac, endocrine, brain-based, attention-bias, and behavioral measures have been used to demonstrate increases in arousal, vigilance, and motor readiness in patients with PNES. The current study uses respiratory measures to assess both the motor readiness of the respiratory system and the respiratory regulation of CO2. Baseline respiratory rates during clinical assessment and arterial CO2 levels during the hyperventilation component of routine video electroencephalogram were documented in 60 children and adolescents referred for treatment of PNES and in 50 controls. Patients showed elevated baseline respiratory rates [t(78) = 3.34, p = .001], with 36/52 (69%) of patients [vs. 11/28 (39%) controls] falling above the 75th percentile (χ 2 = 6.7343; df = 1; p = .009). Twenty-eight (47%) of patients [vs. 4/50 (8%) controls] showed a skewed hyperventilation-challenge profile—baseline PCO2 <36 mmHg, a trough PCO2 ≤ 20 mmHg, or a final PCO2 <36 mmHg after 15 min of recovery—signaling difficulties with CO2 regulation (χ 2 = 19.77; df = 1; p < .001). Children and adolescents with PNES present in a state of readiness-for-action characterized by high arousal coupled with activation of the respiratory motor system, increases in ventilation, and a hyperventilation-challenge profile shifted downward from homeostatic range. Breathing interventions that target arousal, decrease respiratory rate, and normalize ventilation and arterial CO2 may help patients shift brain–body state and avert PNES episodes. The online version of this article (doi:10.1007/s00787-017-0976-0) contains supplementary material, which is available to authorized users.
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