Epilepsi ve Psikojenik Nonepileptik Nöbet Birlikteliği; Psödodirencin Altında Yatan Görünmeyen Tehlike

Psikojenik nonepileptik nöbetler (PNEN), epileptik nöbetler (EN) olarak değerlendirilebilir. Bundan da fazla olarak PNEN, EN’ye eşlik edebilir ve epilepsi hastalarında psödodirenç olarak tanımlayabileceğimiz antiepileptik ilaca (AEİ) direncin nedeni olabilir. Bu çalışmada PNEN ve PNEN ile EN birlikteliğini ve bu hastalarda prognozu değerlendirmeyi amaçladık. 1 Ocak 2007 ve 1 Mart 2016 tarihleri arasında epilepsi merkezine gelen hastaların dosyalarını retrospektif olarak inceledik. Hastaların poliklinik notlarını, nörolojik bulguları, video-EEG monitörizasyonu raporlarını, hastaların ev videolarını, rutin EEG kayıtlarını ve takiplerini değerlendirdik. Toplamda 4247 hasta incelendi ve 114 hastada PNEN saptandı. Sadece PNEN olan 65 hasta, PNEN/EN birlikteliği olan 49 hasta vardı. PNEN/EN birlikteliği olan hastalarda tanı koyma süresi, sadece PNEN olanlara göre daha uzundu (p<0.001). Psikiyatrik tedavi bütün hastalara önerildi, 105 (%92.1) hasta tedaviyi kabul etti, ancak sadece 16 (%15.2) hasta tedaviden fayda gördü. Eğer hasta epilepsi hastası ise genellikle bütün ataklar EN olarak kabul ediliyor ve AEİ dozu ve sayısı, hasta ilaca dirençli kabul edilerek artırılıyor. Biz dirençli epilepsili hastalarda PNEN’den şüphe edilmesinin doğru tanı koymada ve doğru tedavide yardımcı olacağını bulduk. Epilepsi ile ilgilenen klinisyenlerin PNEN’i hep akıllarının bir köşesinde tutması önemlidir.

Anahtar Kelimeler:

Nonepileptik Nöbetler, Nöbet, Prognoz, Tanıda Gecikme

Coexistence of Epilepsy and Psychogenic Nonepileptic Seizures; a Faceless Menace Underlying Pseudointractability

Psychogenic nonepileptic seizures (PNES) may be evaluated as epileptic seizures (ES). Moreover, PNES may be accompanied by ES and might be the cause of resistance to antiepileptic drug (AED) in patients with ES which can be defined as pseudoresistance. We aimed to evaluate the rate of PNES and comorbidity of PNES and ES in our database as well as evaluating the prognosis in these patients. We retrospectively evaluated the records of all patients who were admitted to the epilepsy center between January 1, 2007, and March 31, 2015. Medical record review included outpatient clinic notes, neurological findings, video-EEG monitorization reports, home videos of patients, routine EEG reports, brain images, and follow-up of patients. A total of 4247 patients were evaluated and 114 of these patients had PNES. There were 65 patients with PNES only and 49 patients with PNES/ES. Patients with PNES/ES had a longer duration of diagnosis than patients with PNES (p<0.001). Psychiatric treatment was recommended to all, 105 (92.1%) of them had accepted to go under treatment but only 16 (18%) of them took benefit from treatment. Once the patient had epilepsy, all spells were usually considered as epileptic seizures and dosage and number of AED treatment was increased because it was considered as drug resistant epilepsy. We found that suspicion about PNES in patients with intractable epilepsy is helpful to make the right diagnosis and treatment. The clinician who is interested in patients with epilepsy should always keep PNES in mind.

Keywords:

Diagnostic Delay, Non-Epileptic Seizures, Outcome, Seizure,

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1. Reuber M, Brown RJ. Understanding psychogenic nonepileptic seizures-Phenomenology, semiology and the Integrative Cognitive Model. Seizure. 2017;44:199-205.
2. Angus-Leppan H. Diagnosing epilepsy in neurology clinics: a prospective study. Seizure. 2008;17(5):431-6.
3. Chen-Block S, Abou-Khalil BW, Arain A, et al. Video-EEG results and clinical characteristics in patients with psychogenic nonepileptic spells: The effect of a coexistent epilepsy. Epilepsy Behav. 2016;62:62-5.
4. Martin R, Burneo JG, Prasad A, et al. Frequency of epilepsy in patients with psychogenic seizures monitored by video-EEG. Neurology. 2003;61(12):1791-2.
5. Dickinson P, Looper KJ. Psychogenic nonepileptic seizures: a current overview. Epilepsia. 2012;53(10):1679-89.
6. Kerr WT, Janio EA, Le JM, et al. Diagnostic delay in psychogenic seizures and the association with anti-seizure medication trials. Seizure. 2016;40:123-6.
7. Pretorius C. Barriers and facilitators to reaching a diagnosis of PNES from the patients' perspective: Preliminary findings. Seizure. 2016;38:1-6.
8. Jones SG, TJ OB, Adams SJ, et al. Clinical characteristics and outcome in patients with psychogenic nonepileptic seizures. Psychosom Med. 2010;72(5):487-97.
9. Perez DL, LaFrance WC, Jr. Nonepileptic seizures: an updated review. CNS Spectr. 2016;21(3):239-46.
10. Asadi-Pooya AA, Tinker J. Delay in diagnosis of psychogenic nonepileptic seizures in adults: A post hoc study. Epilepsy Behav. 2017;75:143-5.
11. Asadi-Pooya AA, Sperling MR. Epidemiology of psychogenic nonepileptic seizures. Epilepsy Behav. 2015;46:60-5.
12. Reuber M, Fernandez G, Bauer J, Helmstaedter C, Elger CE. Diagnostic delay in psychogenic nonepileptic seizures. Neurology. 2002;58(3):493-5.
13. Asadi-Pooya AA, Ziyaee F. Outcome of patients with psychogenic nonepileptic seizures with limited resources: A longitudinal study. Seizure. 2018;59:1-4.
14. Tolchin B, Dworetzky BA, Baslet G. Long-term adherence with psychiatric treatment among patients with psychogenic nonepileptic seizures. Epilepsia. 2018;59(1):18-22.
15. Duncan R, Anderson J, Cullen B, Meldrum S. Predictors of 6-month and 3-year outcomes after psychological intervention for psychogenic non epileptic seizures. Seizure. 2016;36:22-6.
16. Baroni G, Martins WA, Piccinini V, et al. Neuropsychiatric features of the coexistence of epilepsy and psychogenic nonepileptic seizures. J Psychosom Res. 2018;111:83-8.