Wadwekar Vaibhav, Nair Pradeep Pankajakshan, Murgai Aditya, Thirunavukkarasu Sibi, Thazhath Harichandrakumar Kottyen
Department of Neurology, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, India.
Department of Biometrics & Informatics (Biostatistics), Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, India.
Seizure. 2014 Mar;23(3):222-6. doi: 10.1016/j.seizure.2013.12.005. Epub 2013 Dec 16.
Different studies have described useful signs to diagnose psychogenic non-epileptic seizure (PNES). A few authors have tried to describe the semiologic groups among PNES patients; each group consisting of combination of features. But there is no uniformity of nomenclature among these studies. Our aim was to find out whether the objective classification system proposed by Hubsch et al. was useful and adequate to classify PNES patient population from South India.
We retrospectively analyzed medical records and video EEG monitoring data of patients, recorded during 3 year period from June 2010 to July 2013. We observed the semiologic features of each PNES episode and tried to group them strictly adhering to Hubsch et al. classification. Minor modifications were made to include patients who were left unclassified.
A total of 65 patients were diagnosed to have PNES during this period, out of which 11 patients were excluded due to inadequate data. We could classify 42(77.77%) patients without modifying the defining criteria of the Hubsch et al. groups. With minor modification we could classify 94.96% patients. The modified groups with patient distribution are as follows: Class 1--dystonic attacks with primitive gestural activities [3(5.6%)]. Class 2 – paucikinetic attacks with or without preserved responsiveness [5(9.3%)]. Class 3--pseudosyncope with or without hyperventilation [21(38.9%)]. Class 4--hyperkinetic prolonged attacks with hyperventilation, involvement of limbs and/or trunk [14(25.9%)]. Class 5--axial dystonic attacks [8(14.8%)]. Class 6--unclassified type [3(5.6%)].
This study demonstrates that the Hubsch's classification with minor modifications is useful and adequate to classify PNES patients from South India.
不同研究描述了诊断精神性非癫痫性发作（PNES）的有用体征。一些作者试图描述PNES患者中的症状学分组；每组由多种特征组合而成。但这些研究在命名上并不统一。我们的目的是确定Hubsch等人提出的客观分类系统对于对来自印度南部的PNES患者群体进行分类是否有用且合适。
我们回顾性分析了2010年6月至2013年7月这3年期间患者的病历和视频脑电图监测数据。我们观察了每例PNES发作的症状学特征，并试图严格按照Hubsch等人的分类进行分组。进行了一些小的修改以纳入未分类的患者。
在此期间共诊断出65例PNES患者，其中11例因数据不足被排除。我们能够在不修改Hubsch等人分组定义标准的情况下对42例（77.77%）患者进行分类。经过小的修改，我们能够对94.96%的患者进行分类。修改后的分组及患者分布如下：1类——伴有原始手势活动的肌张力障碍发作[3例（5.6%）]。2类——伴有或不伴有保留反应性的运动减少发作[5例（9.3%）]。3类——伴有或不伴有过度换气的假性晕厥[21例（38.9%）]。4类——伴有过度换气、肢体和/或躯干受累的运动增多性延长发作[14例（25.9%）]。5类——轴性肌张力障碍发作[8例（14.8%）]。6类——未分类类型[3例（5.6%）]。
本研究表明，经过小的修改后的Hubsch分类对于对来自印度南部的PNES患者进行分类是有用且合适的。
