Rawlings G H, Jamnadas-Khoda J, Broadhurst M, Grünewald R A, Howell S J, Koepp M, Parry S W, Sisodiya S M, Walker M C, Reuber M
Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, S10 2JF, United Kingdom.
Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, S10 2JF, United Kingdom.
Seizure. 2017 May;48:22-27. doi: 10.1016/j.seizure.2017.03.015. Epub 2017 Mar 27.
Previous studies suggest that ictal panic symptoms are common in patients with psychogenic nonepileptic seizures (PNES). This study investigates the frequency of panic symptoms in PNES and if panic symptoms, just before or during episodes, can help distinguish PNES from the other common causes of transient loss of consciousness (TLOC), syncope and epilepsy.
Patients with secure diagnoses of PNES (n=98), epilepsy (n=95) and syncope (n=100) were identified using clinical databases from three United Kingdom hospitals. Patients self-reported the frequency with which they experienced seven symptoms of panic disorder in association with their episodes. A composite panic symptom score was calculated on the basis of the frequency of symptoms.
8.2% of patients with PNES reported "never" experiencing any of the seven panic symptoms in their episodes of TLOC. Patients with PNES reported more frequent panic symptoms in their attacks than those with epilepsy (p<0.001) or syncope (p<0.001), however, patients with PNES were more likely "rarely" or "never" to report five of the seven-ictal panic symptoms than "frequently" or "always" (45-69% versus 13-29%). A receiver operating characteristic analysis demonstrated that the composite panic symptom score distinguished patients with PNES from the other groups (sensitivity 71.1%, specificity 71.2%), but not epilepsy from syncope.
Patients with PNES report TLOC associated panic symptoms more commonly than those with epilepsy or syncope. Although panic symptoms are reported infrequently by most patients with PNES, a composite symptom score may contribute to the differentiation between PNES and the other two common causes of TLOC.
既往研究表明，发作期惊恐症状在精神性非癫痫性发作（PNES）患者中很常见。本研究调查了PNES中惊恐症状的发生率，以及发作前或发作期间的惊恐症状是否有助于将PNES与短暂性意识丧失（TLOC）的其他常见原因（晕厥和癫痫）区分开来。
利用来自英国三家医院的临床数据库，确定了确诊为PNES（n = 98）、癫痫（n = 95）和晕厥（n = 100）的患者。患者自行报告在发作时经历七种惊恐障碍症状的频率。根据症状频率计算出综合惊恐症状评分。
8.2%的PNES患者报告在TLOC发作时“从未”经历过七种惊恐症状中的任何一种。与癫痫患者（p<0.001）或晕厥患者（p<0.001）相比，PNES患者在发作时报告的惊恐症状更频繁，然而，PNES患者比“频繁”或“总是”报告七种发作期惊恐症状中的五种的可能性更高，“很少”或“从未”报告的比例为45 - 69%，而“频繁”或“总是”报告的比例为13 - 29%。受试者工作特征分析表明，综合惊恐症状评分可将PNES患者与其他组区分开来（敏感性71.1%，特异性71.2%），但不能区分癫痫和晕厥。
与癫痫或晕厥患者相比，PNES患者报告的TLOC相关惊恐症状更为常见。尽管大多数PNES患者很少报告惊恐症状，但综合症状评分可能有助于区分PNES与TLOC的其他两种常见原因。
