Spitz M-A, Vercueil L, Dubois-Teklali F
Explorations fonctionnelles du système nerveux, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France.
Arch Pediatr. 2012 Jan;19(1):47-50. doi: 10.1016/j.arcped.2011.10.005. Epub 2011 Nov 18.
Psychogenic nonepileptic seizures are clinical events that mimic epileptic seizures but are not associated with electroencephalographic discharges. These seizures are seldom reported in children in the literature and could be misinterpreted as generalized tonicoclonic seizures. We report the case of a child, already treated for epilepsy, who presented at 8 years of age with several psychogenic seizures leading to pseudostatus epilepticus. After several hospitalizations, the diagnosis of pseudostatus was established on the basis of clinical semiology, lack of EEG abnormalities during the seizures, and a positive provocation maneuver, which elicited and blocked the manifestations. The clinical spectrum of psychogenic seizures is wide and it is particularly difficult to differentiate psychogenic seizures from epileptic seizures, especially when occurring in children, some of whom are already treated for epilepsy. Well-described clinical features can suggest the diagnosis of psychogenic seizure. It is important and necessary to make the diagnosis as soon as possible in order to rapidly begin appropriate treatment including psychotherapy. In fact, the long-term prognosis in children is better than in the adult population. Associated risk factors, such as anxiety as reported in the present case, have to be sought. Recognizing psychogenic seizures will thus avoid their fixation in the child's personality and the risk of inappropriate and escalating treatments leading to iatrogenic complications.
心因性非癫痫性发作是一种临床事件，其症状类似于癫痫发作，但与脑电图放电无关。文献中很少报道儿童出现此类发作，且可能被误诊为全身性强直阵挛发作。我们报告了一例已接受癫痫治疗的儿童病例，该患儿8岁时出现数次心因性发作，导致假性癫痫持续状态。经过数次住院治疗，根据临床症状学、发作期间脑电图无异常以及激发试验阳性（该试验引发并阻断了症状表现），确诊为假性癫痫持续状态。心因性发作的临床谱很广，尤其难以将其与癫痫发作区分开来，特别是在儿童中，其中一些儿童已经在接受癫痫治疗。详细描述的临床特征有助于提示心因性发作的诊断。尽快做出诊断以便迅速开始包括心理治疗在内的适当治疗非常重要且必要。事实上，儿童的心因性发作长期预后优于成人。必须寻找相关危险因素，如本病例中报告的焦虑。认识到心因性发作将避免其在儿童个性中固定下来，以及避免不适当和不断升级的治疗导致医源性并发症的风险。
