Dworetzky Barbara A, Mortati Katherine A, Rossetti Andrea O, Vaccaro Bernardino, Nelson Aaron, Bromfield Edward B
Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Epilepsy Behav. 2006 Sep;9(2):335-8. doi: 10.1016/j.yebeh.2006.06.007. Epub 2006 Jul 26.
Patients with psychogenic nonepileptic seizures (PNES) mimicking status epilepticus (PNES-status) are at risk of iatrogenic complications. Our aim was to assess whether the population of patients with PNES who develop PNES-status are distinguishable. Retrospectively, we identified patients with PNES-status and compared them with patients with PNES without status and with patients with electroclinical status epilepticus (SE). Of 49 patients with PNES, 9 had PNES-status (18.2%) and 40 had PNES only. Compared with patients with PNES, subjects with PNES-status had taken fewer than three antiepileptic medications (P=0.016), had more than one event per week (P=0.026), were more likely to be admitted emergently to the monitoring unit (P=0.007), had shorter long-term monitoring (LTM) stays (P=0.003), and tended to be diagnosed sooner after initial presentation (P=0.058). Use of fewer than three antiepileptic drugs and emergent admission were independent predictors of PNES-status classification on logistic regression. Of 154 patients with epilepsy, 8 had SE during LTM (5.2%), significantly fewer than the proportion with PNES-status relative to PNES (P=0.008); the only clinical variable distinguishing these two groups was a baseline lower seizure frequency among the patients with epileptic seizures (P=0.045). Our results suggest that patients with PNES-status have features that differentiate them from patients with PNES without status and, to a lesser extent, from patients with epileptic seizures.
表现为癫痫持续状态的精神性非癫痫发作（PNES）患者存在医源性并发症风险。我们的目的是评估出现PNES-癫痫持续状态的PNES患者群体是否具有可区分性。我们进行了回顾性研究，确定了患有PNES-癫痫持续状态的患者，并将他们与无癫痫持续状态的PNES患者以及伴有电临床癫痫持续状态（SE）的患者进行比较。在49例PNES患者中，9例出现PNES-癫痫持续状态（18.2%），40例仅有PNES。与PNES患者相比，患有PNES-癫痫持续状态的受试者服用的抗癫痫药物少于三种（P=0.016），每周发作超过一次（P=0.026），更有可能紧急入住监测病房（P=0.007），长期监测（LTM）住院时间较短（P=0.003），且初次就诊后倾向于更快被诊断（P=0.058）。在逻辑回归分析中，使用少于三种抗癫痫药物和紧急入院是PNES-癫痫持续状态分类的独立预测因素。在154例癫痫患者中,8例在LTM期间出现SE（5.2%），明显少于PNES患者中出现PNES-癫痫持续状态的比例（P=0.008）；区分这两组患者的唯一临床变量是癫痫发作患者的基线癫痫发作频率较低（P=0.045）。我们的结果表明，患有PNES-癫痫持续状态的患者具有一些特征，这些特征将他们与无癫痫持续状态的PNES患者区分开来，在较小程度上也与癫痫发作患者区分开来。
