Portland Veterans Affairs Medical Center and Oregon Health & Sciences University, Portland, OR, USA.
Neurology. 2011 Sep 6;77(10):945-50. doi: 10.1212/WNL.0b013e31822cfc46.
Psychogenic nonepileptic seizures (PNES) are frequently encountered in epilepsy monitoring units (EMU) and can result in significant long-term disability. We reviewed our experience with veterans undergoing seizure evaluation in the EMU to determine the time delay to diagnosis of PNES, the frequency of PNES, and cumulative antiepileptic drug (AED) treatment. We compared veterans with PNES to civilians with PNES studied in the same EMU.
We reviewed records of all patients admitted to one Veterans Affairs Medical Center (VAMC) EMU over a 10-year interval. These patients included 203 veterans and 726 civilians from the university affiliate. The percentage of patients with PNES was calculated for the veteran and civilian groups. Fifty veterans with only PNES were identified. Each veteran with PNES was matched to the next civilian patient with PNES. The 2 groups were compared for interval from onset of the habitual spells to EMU diagnosis, cumulative AED treatment, and other measures.
PNES were identified in 25% of veterans and 26% of civilians admitted to the EMU. The delay from onset of spells to EMU diagnosis averaged 60.5 months for veterans and 12.5 months for civilians (p < 0.001). Cumulative AED treatment was 4 times greater for veterans with PNES as compared to civilians (p < 0.01). Fifty-eight percent of veterans with PNES were thought to have seizures related to traumatic brain injury.
The results indicate a substantial delay in the diagnosis of PNES in veterans as compared to civilians. The delay is associated with greater cumulative AED treatment.
心因性非癫痫性发作（PNES）在癫痫监测单元（EMU）中经常遇到，可导致严重的长期残疾。我们回顾了我们在 EMU 中对退伍军人进行癫痫评估的经验，以确定 PNES 的诊断时间延迟、PNES 的频率以及累积抗癫痫药物（AED）治疗情况。我们将患有 PNES 的退伍军人与在同一 EMU 中研究的患有 PNES 的平民进行了比较。
我们回顾了在 10 年期间入住一家退伍军人事务医疗中心（VAMC）EMU 的所有患者的记录。这些患者包括来自大学附属医院的 203 名退伍军人和 726 名平民。计算了退伍军人和平民组中患有 PNES 的患者的百分比。确定了 50 名仅有 PNES 的退伍军人。每位患有 PNES 的退伍军人都与下一位患有 PNES 的平民患者相匹配。比较了两组从习惯性发作开始到 EMU 诊断、累积 AED 治疗以及其他措施的时间间隔。
在入住 EMU 的退伍军人和平民中，分别有 25%和 26%被诊断为 PNES。退伍军人从发作开始到 EMU 诊断的平均时间延迟为 60.5 个月，平民为 12.5 个月（p<0.001）。与平民相比，患有 PNES 的退伍军人的累积 AED 治疗量增加了 4 倍（p<0.01）。58%的患有 PNES 的退伍军人被认为与创伤性脑损伤有关。
与平民相比，退伍军人 PNES 的诊断存在明显延迟。这种延迟与更大的累积 AED 治疗有关。
