Ayşe SERDAROĞLU, Erhan BİLİR, Gülnihal KUTLU

Psychogenic nonepileptic seizures and induction with intravenous saline placebo

Amaç: Epileptik nöbet ile psikofenik nonepileptik nöbetler ayrımı bazen oldukça zor olabilir ve uzun süreli video/EEG monitorizasyon kesin tam için gerekli olabilir Hastalar ve Metod: Ekim 1997- Kasım 2001 tarihleri arasında Gazi Hastanesi Epilepsi Merkezinde 352 hasta monitorize edilmiştir. Yüz seksen bir olgu çocukluk yaş grubundadır. 49 olguda psikoienik nonepileptik nöbetler saptanmıştır. Bu olguların 27' sine nöbet indüksiyonu yapılmıştır. Hastalar devamlı olarak en az 24 saat monitorize edilmişlerdir. Tüm kaydedilen klinik olaylar ve EEG' 1er nörologlar tarafından değerlendirilmiştir. Sonuçlar: Psikojenik nonepileptik nöbetler tanışı alan olguların yaş ortalaması 22.34'tür. 32 (%65.31) olgu kadın, 17 (%34.69) olgu erkektir. Yirmi altı (%96.3) olguda indüksiyon sonrası tipik nöbet izlenmiş olup, bu sırada elde edilen preiktal, iktal, postiktal EEG' de artefaktlar dışında bir değişikliğe rastlanmamıştır. On iki olgu, monitorizasyon öncesi refrakter epilepsi tanısı almıştır ve tamamı yüksek doz antiepileptik ilaçlar kullanmaktaydı. Bunların dördünde epilepsi ve psikoienik nonepileptik nöbetler birlikteliği düşünülmüştü, Tartışma: Video/EEG monitorizasyon psikofenik nonepileptik nöbetler teşhisinde en etkin yöntemlerden birisidir. Provokasyon teknikleri tam için yararlıdır, ayrıca zaman ve para tasarrufu sağlar.

Psikojenik nonepileptiik nöbetler ve plasebo serum fizyolojik ile indüksiyon

Purpose: The differentiation between an epileptic seizure and psychogenic nonepileptic seizure is sometimes very difficult, and prolonged video/EEC monitoring may be necessary for certain diagnosis. Patients and Methods: Three hundred fifty-two patients were monitored at the video/EEG telemetry unit of the Comprehensive Epilepsy Center of Gazi Hospital between October 1997 and November 2001. One hundred eighty-one of the 352 were children. Our primary goal was to identify and categorize the events observed. In 49 cases, psychogenic nonepileptic seizures were documented. Of those, 27 patients underwent attempted induction of seizure. At least 24 h of video/EEG telemetry were recorded continuously. A neurologist evaluated all recorded clinical events and EEG. Results: Mean age at the time of the diagnosis of psychogenic nonepileptic seizure was 22.34 years. Psychogenic nonepileptic seizure patients consisted of 32 (65.3%) females and 17 (34.7%) males. Twenty-six (96.3%) patients had a typical seizure after induction; there were no preictal, ictal or postictal EEG changes except for artifacts. Twelve cases (25%) had previously diagnosed refractory epilepsy, and all of them used high-dose antiepileptic drugs. Four of them were diagnosed with both epilepsy and psychogenic nonepileptic seizure. Discussion: Video/EEG monitoring is an effective tool for the diagnosis of psychogenic nonepileptic seizures. Provocative techniques are useful in the diagnosis of psychogenic NES, and are also cost-effective and timesaving.

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