Wissel Benjamin D, Dwivedi Alok K, Gaston Tyler E, Rodriguez-Porcel Federico J, Aljaafari Danah, Hopp Jennifer L, Krumholz Allan, van der Salm Sandra M A, Andrade Danielle M, Borlot Felippe, Moseley Brian D, Cavitt Jennifer L, Williams Stevie, Stone Jon, LaFrance W Curt, Szaflarski Jerzy P, Espay Alberto J
Department of Neurology and Rehabilitative Medicine, University of Cincinnati, Cincinnati, OH, USA.
Division of Biostatistics & Epidemiology, Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX, USA.
Epilepsy Behav. 2016 Aug;61:180-184. doi: 10.1016/j.yebeh.2016.05.032. Epub 2016 Jun 27.
We sought to examine the clinical and electrographic differences between patients with combined epileptic (ES) and psychogenic nonepileptic seizures (PNES) and age- and gender-matched patients with ES-only and PNES-only.
Data from 138 patients (105 women [77%]), including 46 with PNES/ES (39±12years), 46 with PNES-only (39±11years), and 46 with ES-only (39±11years), were compared using logistic regression analysis after adjusting for clustering effect.
In the cohort with PNES/ES, ES antedated PNES in 28 patients (70%) and occurred simultaneously in 11 (27.5%), while PNES were the initial presentation in only 1 case (2.5%); disease duration was undetermined in 6. Compared with those with ES-only, patients with PNES/ES had higher depression and anxiety scores, shorter-duration electrographic seizures, less ES absence/staring semiology (all p≤0.01), and more ES arising in the right hemisphere, both in isolation and in combination with contralateral brain regions (61% vs. 41%; p=0.024, adjusted for anxiety and depression) and tended to have less ES arising in the left temporal lobe (13% vs. 28%; p=0.054). Compared with those with PNES-only, patients with PNES/ES tended to show fewer right-hemibody PNES events (7% vs. 23%; p=0.054) and more myoclonic semiology (10% vs. 2%; p=0.073).
Right-hemispheric electrographic seizures may be more common among patients with ES who develop comorbid PNES, in agreement with prior neurobiological studies on functional neurological disorders.
我们试图研究合并癫痫性发作（ES）和精神性非癫痫性发作（PNES）的患者与年龄及性别匹配的单纯ES患者和单纯PNES患者之间的临床及脑电图差异。
对138例患者（105例女性[77%]）的数据进行分析，其中包括46例合并PNES/ES的患者（39±12岁）、46例单纯PNES患者（39±11岁）和46例单纯ES患者（39±11岁），在调整聚类效应后采用逻辑回归分析进行比较。
在合并PNES/ES的队列中，28例患者（70%）ES先于PNES出现，11例（27.5%）同时出现，而PNES仅在1例患者（2.5%）中为首发表现；6例患者疾病持续时间未确定。与单纯ES患者相比，合并PNES/ES的患者抑郁和焦虑评分更高、脑电图发作持续时间更短、ES失神/凝视发作表现更少（均p≤0.01），且孤立及与对侧脑区合并出现时，右侧半球出现ES的情况更多（61%对41%；p=0.024，经焦虑和抑郁调整），左侧颞叶出现ES的情况则较少（13%对28%；p=0.054）。与单纯PNES患者相比，合并PNES/ES的患者右侧半身PNES事件往往较少（7%对23%；p=0.054），肌阵挛发作表现较多（10%对2%；p=0.073）。
合并PNES的ES患者中右侧半球脑电图发作可能更常见，这与先前关于功能性神经障碍的神经生物学研究结果一致。
