Kerr Wesley T, Janio Emily A, Le Justine M, Hori Jessica M, Patel Akash B, Gallardo Norma L, Bauirjan Janar, Chau Andrea M, D'Ambrosio Shannon R, Cho Andrew Y, Engel Jerome, Cohen Mark S, Stern John M
Department of Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States.
Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States.
Seizure. 2016 Aug;40:123-6. doi: 10.1016/j.seizure.2016.06.015. Epub 2016 Jun 23.
The average delay from first seizure to diagnosis of psychogenic non-epileptic seizures (PNES) is over 7 years. The reason for this delay is not well understood. We hypothesized that a perceived decrease in seizure frequency after starting an anti-seizure medication (ASM) may contribute to longer delays, but the frequency of such a response has not been well established.
Time from onset to diagnosis, medication history and associated seizure frequency was acquired from the medical records of 297 consecutive patients with PNES diagnosed using video-electroencephalographic monitoring. Exponential regression was used to model the effect of medication trials and response on diagnostic delay.
Mean diagnostic delay was 8.4 years (min 1 day, max 52 years). The robust average diagnostic delay was 2.8 years (95% CI: 2.2-3.5 years) based on an exponential model as 10 to the mean of log10 delay. Each ASM trial increased the robust average delay exponentially by at least one third of a year (Wald t=3.6, p=0.004). Response to ASM trials did not significantly change diagnostic delay (Wald t=-0.9, p=0.38).
Although a response to ASMs was observed commonly in these patients with PNES, the presence of a response was not associated with longer time until definitive diagnosis. Instead, the number of ASMs tried was associated with a longer delay until diagnosis, suggesting that ASM trials were continued despite lack of response. These data support the guideline that patients with seizures should be referred to epilepsy care centers after failure of two medication trials.
从首次癫痫发作到诊断为精神性非癫痫性发作（PNES）的平均延迟超过7年。这种延迟的原因尚不清楚。我们假设开始使用抗癫痫药物（ASM）后癫痫发作频率的感知下降可能导致更长的延迟，但这种反应的频率尚未得到很好的确立。
从297例连续使用视频脑电图监测诊断为PNES的患者的病历中获取从发病到诊断的时间、用药史和相关癫痫发作频率。使用指数回归模型来模拟药物试验及其反应对诊断延迟的影响。
平均诊断延迟为8.4年（最短1天，最长52年）。基于指数模型，稳健的平均诊断延迟为2.8年（95%置信区间：2.2 - 3.5年），即10的延迟对数均值。每次ASM试验使稳健的平均延迟以指数方式增加至少三分之一年（Wald t = 3.6，p = 0.004）。对ASM试验的反应并未显著改变诊断延迟（Wald t = -0.9，p = 0.38）。
虽然在这些PNES患者中普遍观察到对ASM有反应，但这种反应的存在与确诊前的时间延长无关。相反，尝试使用ASM的次数与诊断延迟时间延长有关，这表明尽管没有反应仍继续进行ASM试验。这些数据支持了癫痫发作患者在两次药物试验失败后应转诊至癫痫护理中心的指南。
