Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
Epilepsy Behav. 2011 Aug;21(4):364-6. doi: 10.1016/j.yebeh.2011.06.003. Epub 2011 Jul 6.
Psychogenic nonepileptic seizures (PNES) are common paroxysmal events that mimic and can often be misdiagnosed as epileptic seizures. PNES account for 10 to 40% of patients referred to epilepsy centers. Patients with uncontrolled PNES are at times subjected to vagus nerve stimulator (VNS) implantation. We report a series of such referred patients studied with video/EEG monitoring at our institution.
We evaluated patients who were implanted with a VNS by their primary neurologist for refractory seizures and who were referred to the Vanderbilt University epilepsy monitoring unit for a second opinion. The presumed diagnosis of epilepsy was based on abnormal routine EEG studies obtained by their primary neurologist. We evaluated these patients and recorded their typical spells between 2005 and 2009. We describe the results of 13 patients with VNS who were found to have PNES. The total number of patients with a VNS studied during this time was 60.
None of the patients had undergone prior long-term video/EEG monitoring to document the nature of their events. A total of 13 patients with an implanted VNS had exclusive PNES, 9 women and 4 men with a mean age of 38.2±10.4 years. Mean age at seizure onset was 28.5±15.4 years. Patients were taking two to four antiepileptic medications in addition to VNS at the time of video/EEG monitoring. The average latency from the time of VNS implantation to the confirmatory diagnosis was 2.8 years. One to ten (median=3) of these patients' typical seizures were recorded during video/EEG monitoring. All patients were subsequently discharged off antiepileptic medications, and five of these patients were discharged home with the VNS turned off.
A VNS may be implanted inappropriately in patients with PNES. As video/EEG monitoring may help in excluding the diagnosis of PNES and preventing unnecessary VNS implants, it should be a requirement before VNS implantation.
心因性非癫痫性发作（PNES）是一种常见的阵发性事件，可模仿癫痫发作，且常被误诊为癫痫发作。PNES 占癫痫中心转诊患者的 10%至 40%。对于未得到控制的 PNES 患者，有时会进行迷走神经刺激器（VNS）植入。我们报告了一系列在我们机构进行视频/脑电图监测的此类转诊患者。
我们评估了由其主要神经科医生为治疗难治性癫痫而植入 VNS 的患者，并将他们转诊到范德比尔特大学癫痫监测单位进行第二次诊断。癫痫的假定诊断基于他们的主要神经科医生获得的异常常规 EEG 研究。我们评估了这些患者，并记录了他们在 2005 年至 2009 年之间的典型发作。我们描述了在此期间进行 VNS 研究的 60 名患者中 13 名患有 PNES 的患者的结果。
这些患者均未进行过先前的长期视频/脑电图监测以记录其发作的性质。共有 13 名植入 VNS 的患者存在单纯的 PNES，9 名女性和 4 名男性，平均年龄为 38.2±10.4 岁。癫痫发作的平均年龄为 28.5±15.4 岁。在进行视频/脑电图监测时，患者除 VNS 外还服用两种至四种抗癫痫药物。从植入 VNS 到确诊的平均潜伏期为 2.8 年。在视频/脑电图监测期间记录了这些患者典型发作的 1 至 10 次（中位数=3 次）。所有患者随后停用抗癫痫药物，其中 5 名患者停用 VNS 并出院。
PNES 患者可能会不恰当地植入 VNS。由于视频/脑电图监测有助于排除 PNES 的诊断并防止不必要的 VNS 植入，因此在植入 VNS 之前应成为一项要求。
