Selma ZİNCİR BOZKURT, Aynil YENEL, Ümit Başar SEMİZ

Approach to Patients with ‘Psychogenic Non-Epileptic Seizures’: A Review

Epileptik olmayan nöbetler için histerik nöbet, histeroepilepsi veya psikojenik nöbet kavramlarını da içeren pek çok tanımlama kullanılmaktadır. Bu tanımlamalar arasında ‘epileptik olmayan psikojenik nöbet’ terimi daha çok tercih edilir. Epileptik olmayan psikojenik bu nöbetler, görünüşte epileptik nöbetlere tamamen benzese de, ortaya çıkış nedenleri tamamen psikojeniktir. Epileptik olmayan psikojenik nöbetler, modern psikiyatride konversiyon ve dissosiyatif bozukluk olarak tanımlanır ve bu hastalıklar, aynı zamanda depresyon, posttravmatik stres bozuklukları ve kişilik bozuklukları gibi diğer psikiyatrik problemlerle bir arada bulunur. Bu makalenin amacı psikojenik epileptik olmayan nöbetleri olan hastalarla epilepsisi olan hastalar arasında epidemiyolojik, psikiyatrik ve semiyolojik değişkenlerdeki benzerlik ve farklılıkları karşılaştırmak ve tanımlamaktır. Klinik belirti ve bulgulara dayanarak, doğru teşhise ulaşmak için epileptik olmayan psikojenik nöbetlerin doğasını iyi anlamak, doğru tedaviyi uygulayabilmenin en önemli parçasıdır. Psikojenik nöbetler paroksismal davranışlarla seyreder ve antiepileptik tedaviye yanıt vermezler. Yeni başlangıçlı psikojenik nöbetlerle psikojenik olmayan nöbetler arasındaki sistematik kıyaslamalar, eşlik eden psikolojik semptomları ve etiyolojiyi anlamak açısından önemlidir. Travmatik deneyimler, psikojenik nöbet geçiren hastalar için aynı zamanda potansiyel bir risk faktörüdür. Kanıtlar, bazı psikojenik epilepsilerin etiyolojisinde çocukluk çağı travmalarının rolü olabileceğini düşündürtmektedir. Buna benzer çalışmalar, gerçek epileptik vakalarla psikojenik epilepsilerin erken ayırıcı tanısının oldukça zor olduğuna dikkat çekmesi açısından incelemeye değerdir.

Psikojenik epileptik olmayan nöbetleri olan hastalara yaklaşım: Bir derleme

Several terms have been used for pseudo-seizures, including psychogenic non-epileptic seizures (PNES), psychogenic seizures, hysterical seizures and hysteroepilepsy. Among them, the term ‘non-epileptic seizures’ is preffered. PNES outwardly may appear similar to epilepsy, but are caused purely by emotion. PNES are defined by modern psychiatry as conversion and dissociative disorders, but these disorders may coexist with many other psychiatric disorders including depression, posttraumatic stress disorder and personality disorders. The aim of this article is to describe and to compare similarities and differences in epidemiological, psychiatric and semiologic variables between patients with psychogenic non-epileptic seizures and other patients with epilepsy. Understanding the nature of psychogenic non-epileptic seizures is necessary in order to reach the right diagnosis based on clinical symptoms and signs. Once a firm diagnosis has been reached, presenting that diagnosis to the individual patient is the first, and one of the most important part of the treatment. Nonepileptic seizures, also reffered to as pseudoseizures, are paroxysmal behaviors with psychological comorbidities and are unresponsive to treatment with antiepileptic drugs. Systematic comparisons between patients with recent onset psychogenic seizures and patients with recent onset non-psychogenic seizures may lead to a better understanding of psychological concomitants and perhaps the aetiology of psychogenic seizures. A traumatic experience may be a potential risk factor for patients with PNES. The evidence suggests that a history of childhood abuse might be involved in the aetiology of at least some cases of psychogenic seizures. Such studies are important considering the early differential diagnosis of true epileptic versus psychogenic fits is notoriously difficult.

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