González Otárula Karina A, Tan Yee-Leng, Dubeau François, Correa José A, Chang Edward, Hall Jeffery A, Knowlton Robert C, Kobayashi Eliane
Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Canada.
University of California San Francisco Medical Center, USA; Department of Neurology, National Neuroscience Institute, Singapore.
Epilepsy Behav. 2017 Oct;75:252-255. doi: 10.1016/j.yebeh.2017.08.015. Epub 2017 Sep 1.
Whether occurring before or after an epilepsy surgery, psychogenic nonepileptic seizures (PNES) impact treatment options and quality of life of patients with epilepsy. We investigated the frequency of pre- and postsurgical PNES, and the postsurgical Engel and psychiatric outcomes in patients with drug-resistant temporal lobe epilepsy (TLE). We reviewed 278 patients with mean age at surgery of 37.1±12.4years. Postsurgical follow-up information was available in 220 patients, with average follow-up of 4years. Nine patients (9/278 or 3.2%) had presurgical documented PNES. Eight patients (8/220 or 3.6%) developed de novo PNES after surgery. Pre- and postsurgery psychiatric comorbidities were similar to the patients without PNES. After surgery, in the group with presurgical PNES, five patients were seizure-free, and three presented persistent PNES. In the group with de novo postsurgery PNES, 62.5% had Engel II-IV, and 37.5% had Engel I. All presented PNES at last follow-up. Presurgical video-EEG monitoring is crucial in the diagnosis of coexisting PNES. Patients presenting presurgical PNES and drug-resistant TLE should not be denied surgery based on this comorbidity, as they can have good postsurgical epilepsy and psychiatric outcomes. Psychogenic nonepileptic seizures may appear after TLE surgery in a low but noteworthy proportion of patients regardless of the Engel outcome.
无论在癫痫手术之前还是之后发生，精神性非癫痫性发作（PNES）都会影响癫痫患者的治疗选择和生活质量。我们调查了药物难治性颞叶癫痫（TLE）患者术前和术后PNES的发生率，以及术后的恩格尔（Engel）分级和精神状态结果。我们回顾了278例患者，手术时的平均年龄为37.1±12.4岁。220例患者有术后随访信息，平均随访时间为4年。9例患者（9/278，即3.2%）术前记录有PNES。8例患者（8/220，即3.6%）术后出现新发PNES。术前和术后的精神共病情况与无PNES的患者相似。术后，术前有PNES的组中，5例患者无癫痫发作，3例仍有持续性PNES。在术后新发PNES的组中，62.5%的患者恩格尔分级为II-IV级，37.5%为I级。所有患者在最后一次随访时均有PNES发作。术前视频脑电图监测对共存PNES的诊断至关重要。术前有PNES和药物难治性TLE的患者不应因这种共病而被拒绝手术，因为他们术后癫痫和精神状态可能有良好的结果。无论恩格尔分级结果如何，精神性非癫痫性发作在低比例但值得注意的TLE手术患者中可能会在术后出现。
