Evidence-Based Practice for the Clinical Assessment of Psychogenic Nonepileptic Seizures: A Report From the American Neuropsychiatric Association Committee on Research
Evidence-Based Practice for the Clinical Assessment of Psychogenic Nonepileptic Seizures: A Report From the American Neuropsychiatric Association Committee on Research
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DOI：
10.1176/appi.neuropsych.19120354
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发表时间：
2021-06-01
影响因子：
2.9
通讯作者：
LaFrance, W. Curt, Jr.
中科院分区：
文献类型：
--
作者：
Baslet, Gaston;Bajestan, Sepideh N.;LaFrance, W. Curt, Jr.
美国神经精神病学协会的研究委员会分配的任务是定义最有帮助的临床因素和测试，在神经精神病学评估期间建立心因性非癫痫性发作（PNES）的诊断。使用三个搜索引擎和指定的PNES和预定的临床因素和诊断测试的检索词进行了文献的系统综述，然后使用特定标准进行选择过程。列出了选定文章的临床因素（症状学、精神病合并症、医学合并症、心理特征）和诊断测试（EEG、心理测量和神经心理学测量、催乳素水平、临床神经影像学、自主神经测试）的数据提取结果。视频脑电图（vEEG）的符号学仍然是最有价值的工具，以确定PNES的诊断。除符号学外，很少有研究揭示了PNES的临床因素的预测价值，并且这些发现在大多数情况下都是孤立的，无法复制。感应技术，特别是当与vEEG结合时，可以导致捕获事件，然后确认诊断。在没有捕获事件的情况下，事件后催乳素水平和个性评估可以支持诊断，但需要与其他临床因素仔细结合。对疑似PNES患者进行全面的临床评估可以确定几个临床因素，并可能包括一些可以支持PNES诊断的测试。当无法获得在vEEG上具有典型符号学的捕获事件的金标准时，这尤其相关。
The American Neuropsychiatric Association's Committee on Research assigned the task of defining the most helpful clinical factors and tests in establishing the diagnosis of psychogenic nonepileptic seizures (PNES) during a neuropsychiatric assessment. A systematic review of the literature was conducted using three search engines and specified search terms for PNES and the predetermined clinical factors and diagnostic tests, followed by a selection process with specific criteria. Data extraction results from selected articles are presented for clinical factors (semiology, psychiatric comorbidities, medical comorbidities, psychological traits) and diagnostic tests (EEG, psychometric and neuropsychological measures, prolactin level, clinical neuroimaging, autonomic testing). Semiology with video EEG (vEEG) remains the most valuable tool to determine the diagnosis of PNES. With the exception of semiology, very few studies revealed the predictive value of a clinical factor for PNES, and such findings were isolated and not replicated in most cases. Induction techniques, especially when coupled with vEEG, can lead to a captured event, which then confirms the diagnosis. In the absence of a captured event, postevent prolactin level and personality assessment can support the diagnosis but need to be carefully contextualized with other clinical factors. A comprehensive clinical assessment in patients with suspected PNES can identify several clinical factors and may include a number of tests that can support the diagnosis of PNES. This is especially relevant when the gold standard of a captured event with typical semiology on vEEG cannot be obtained.