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创伤性脑损伤和心因性非癫痫性发作会导致更差的结果。

Traumatic brain injury and psychogenic nonepileptic seizures yield worse outcomes.

机构信息

Departments of Neurology Psychiatry, Rhode Island Hospital, Providence, RI 02903, USA.

出版信息

Epilepsia. 2013 Apr;54(4):718-25. doi: 10.1111/epi.12053. Epub 2013 Jan 2.

Abstract

PURPOSE

To investigate the relationship between traumatic brain injury (TBI) and psychogenic nonepileptic seizures (PNES). We hypothesized that PNES with TBI would be associated with more psychiatric comorbidities and disability than PNES without TBI.

METHODS

In this cross-sectional study comparing patients with PNES with TBI to patients with PNES without TBI, medical records from 255 consecutive patients with electroencephalography (EEG)-confirmed PNES were reviewed to assess variables including demographic, head injury, neurologic, psychiatry, social variables, and quality of life and symptoms scales. Parametric, analysis of covariance (ANCOVA), and logistic regression analyses were performed, to compare psychiatric and function variables between the two study groups while controlling for age and sex.

KEY FINDINGS

Of the 92 patients with PNES who fulfilled inclusion/exclusion criteria, 41 (44.6%) had a history of TBI. Of the 41 patients with TBI, 30 (73%) met criteria for mild TBI (mTBI). Patients with TBI had more mood disorder diagnoses, were more likely to receive disability, and had lower global functioning than non-TBI patients with PNES, after adjusting for age and sex. Patients with TBI and PNES had significantly increased odds for having major depression, behavioral impulsivity, posttraumatic stress disorder diagnosis, and a trauma/abuse history.

SIGNIFICANCE

TBI is a significant risk factor in patients with PNES, being associated with increased psychiatric diagnostic comorbidity, symptoms severity, poorer functioning, and increased disability. This study reveals the importance of identifying and addressing the impact of TBI in patients with seizure disorders. Addressing the sequelae of TBI in PNES may be a target to improve functioning.

摘要

目的

研究创伤性脑损伤(TBI)与心因性非癫痫性发作(PNES)之间的关系。我们假设,与无脑损伤的 PNES 相比,合并 TBI 的 PNES 与更多的精神共病和残疾有关。

方法

在这项比较 TBI 后 PNES 患者与无脑损伤的 PNES 患者的横断面研究中,我们对 255 例脑电图(EEG)确诊的 PNES 患者的病历进行了回顾性评估,以评估包括人口统计学、头部外伤、神经学、精神病学、社会变量以及生活质量和症状量表在内的变量。进行了参数、协方差分析(ANCOVA)和逻辑回归分析,以比较两组研究对象的精神病学和功能变量,同时控制年龄和性别。

主要发现

在符合纳入/排除标准的 92 例 PNES 患者中,有 41 例(44.6%)有 TBI 病史。在这 41 例 TBI 患者中,有 30 例(73%)符合轻度 TBI(mTBI)的标准。在调整年龄和性别后,与无脑损伤的 PNES 患者相比,TBI 患者的心境障碍诊断更多,更有可能获得残疾,且总体功能更差。TBI 合并 PNES 的患者发生重度抑郁症、行为冲动、创伤后应激障碍诊断和创伤/虐待史的几率显著增加。

意义

TBI 是 PNES 患者的一个重要危险因素,与更高的精神共病率、症状严重程度、更差的功能和更高的残疾率有关。这项研究揭示了在癫痫患者中识别和处理 TBI 影响的重要性。解决 PNES 中的 TBI 后遗症可能是改善功能的目标。

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