Managing Functional Neurological Disorders: Protocol of a Cohort Study on Psychogenic Non-Epileptic Seizures Study
Managing Functional Neurological Disorders: Protocol of a Cohort Study on Psychogenic Non-Epileptic Seizures Study
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DOI：
10.2147/ndt.s234852
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发表时间：
2019-01-01
影响因子：
3.2
通讯作者：
Pugh, Mary Jo
中科院分区：
文献类型：
--
作者：
Altalib, Hamada Hamid;Galluzzo, Daniela;Pugh, Mary Jo
背景资料：功能性神经系统疾病（FND）是不能由潜在的神经病变或其他医学疾病解释的神经系统症状，并且没有明确的神经病理学相关性。心因性非癫痫性发作（PNES）是FND的一种常见且高度致残的形式，其特征在于阵发性不自主运动和意识改变，临床上可能与癫痫发作相似。PNES在FND中是独特的，因为它们是通过视频脑电图（VEEG）诊断的，这是一种成熟的疾病生物标志物。PNES的病程和治疗反应仍有争议。本研究的目的是描述的流行病学PNES在退伍军人事务部医疗保健系统（VA），评估结果的退伍军人提供不同的治疗，并比较模型的护理PNES.Methods：这个电子健康记录（EHR）队列研究利用信息学搜索工具和自然语言处理算法，以确定全国范围内的PNES病例。我们将使用所有170个医疗中心的VA住院、门诊、药房和图表摘要数据来识别2002-2018财年的病例。结果测量，如癫痫发作频率，急诊室就诊，住院，自杀相关行为，并利用心理治疗之前和之后PNES diagnosis将被用来评估模型的有效性care.Discussion：本研究将描述的风险因素和治疗过程中的一大群人与PNES。由于PNES通过各种不同的方式、治疗方向和护理模式进行护理，因此将评估有效性结局，如癫痫发作结局和癫痫发作急诊访视的利用率。结果测量，如癫痫发作频率，急诊室就诊，住院，自杀相关行为，以及PNES诊断前后的心理治疗将用于评估护理模式的有效性。
Background: Functional neurological disorders (FNDs) are neurological symptoms that cannot be explained by an underlying neurological lesion or other medical illness and that do not have clear neuropathological correlates. Psychogenic non-epileptic seizures (PNES) are a common and highly disabling form of FND, characterized by paroxysmal episodes of involuntary movements and altered consciousness that can appear clinically similar to epileptic seizures. PNES are unique among FNDs in that they are diagnosed by video electroencephalographic (VEEG), a well-established biomarker for the disorder. The course of illness and response to treatment of PNES remain controversial. This study aims to describe the epidemiology of PNES in the Department of Veterans Affairs Healthcare System (VA), evaluate outcomes of veterans offered different treatments, and compare models of care for PNES.Methods: This electronic health record (EHR) cohort study utilizes an informatics search tool and a natural language processing algorithm to identify cases of PNES nationally. We will use VA inpatient, outpatient, pharmacy, and chart abstraction data across all 170 medical centers to identify cases in fiscal years 2002-2018. Outcome measurements such as seizure frequency, emergency room visits, hospital admissions, suicide-related behavior, and the utilization of psychotherapy prior to and after PNES diagnosis will be used to assess the effectiveness of models of care.Discussion: This study will describe the risk factors and course of treatment of a large cohort of people with PNES. Since PNES are cared for by a variety of different modalities, treatment orientations, and models of care, effectiveness outcomes such as seizure outcomes and utilization of emergency visits for seizures will be assessed. Outcome measurements such as seizure frequency, emergency room visits, hospital admissions, suicide-related behavior, and psychotherapy prior to and after PNES diagnosis will be used to assess the effectiveness of models of care.