Krumholz A
Department of Neurology, University of Maryland School of Medicine, Baltimore, USA.
Neurology. 1999;53(5 Suppl 2):S76-83.
Nonepileptic seizures are disorders that are mistaken for epilepsy. They may be caused by physiologic or psychological disturbances but, unlike true epilepsy, nonepileptic seizures are not the consequence of abnormal electrical discharges in the brain. Nonepileptic seizures related to psychological causes are termed "nonepileptic psychogenic seizures" and account for approximately 20% of all intractable seizure disorders. These seizures are often misdiagnosed as true epilepsy, resulting in inappropriate, ineffective, and costly treatment of many patients. Clinical observation has long been the basis for distinguishing nonepileptic from epileptic seizures. Recent advances in video-EEG monitoring have tremendously improved the ability of experienced epilepsy specialists to correctly distinguish nonepileptic seizures from epilepsy, but access to epilepsy experts and comprehensive epilepsy monitoring centers remains limited for many patients. Moreover, even after a correct diagnosis is made a high proportion of such patients continue to have seizures and serious disability. Recent evidence suggests that patients with nonepileptic seizures may benefit from structured treatment programs and extended support from epilepsy centers. As knowledge about the nature of psychogenic seizures and their associated psychopathology is gained, better treatment strategies can be developed that will improve the care and prognosis of these difficult and challenging patients.
非癫痫性发作是被误诊为癫痫的病症。它们可能由生理或心理紊乱引起，但与真正的癫痫不同，非癫痫性发作并非大脑异常放电的结果。与心理原因相关的非癫痫性发作被称为“非癫痫性心因性发作”，约占所有难治性发作性疾病的20%。这些发作常常被误诊为真正的癫痫，导致许多患者接受不恰当、无效且昂贵的治疗。长期以来，临床观察一直是区分非癫痫性发作和癫痫性发作的基础。视频脑电图监测的最新进展极大地提高了经验丰富的癫痫专家正确区分非癫痫性发作和癫痫的能力，但许多患者仍难以获得癫痫专家和综合癫痫监测中心的服务。此外，即使做出了正确诊断，此类患者中仍有很大比例继续发作并伴有严重残疾。最近的证据表明，非癫痫性发作患者可能受益于结构化治疗方案以及癫痫中心提供的长期支持。随着对心因性发作的本质及其相关精神病理学的了解不断深入，可以制定出更好的治疗策略，从而改善这些病情复杂且具有挑战性的患者的护理和预后。
