Kozlowska Kasia, Chudleigh Catherine, Cruz Catherine, Lim Melissa, McClure Georgia, Savage Blanche, Shah Ubaid, Cook Averil, Scher Stephen, Carrive Pascal, Gill Deepak
1 Department of Psychological Medicine, The Children's Hospital at Westmead, NSW, Australia.
2 Brain Dynamics Centre at atWestmead Institute for Medical Research, NSW, Australia.
Clin Child Psychol Psychiatry. 2018 Jan;23(1):160-176. doi: 10.1177/1359104517730116. Epub 2017 Sep 28.
Psychogenic non-epileptic seizures (PNES) - time-limited disturbances of consciousness and motor-sensory control, not accompanied by ictal activity on electroencephalogram (EEG) - are best conceptualized as atypical neurophysiological responses to emotional distress, physiological stressors and danger. Patients and families find the diagnosis of PNES difficult to understand; the transition from neurology (where the diagnosis is made) to mental health services (to which patients are referred for treatment) can be a bumpy one. This study reports how diagnostic formulations constructed for 60 consecutive children and adolescents with PNES were used to inform both the explanations about PNES that were given to them and their families and the clinical interventions that were used to help patients gain control over PNES. Families were able to accept the diagnosis of PNES and engage in treatment when it was explained how emotional distress, illness and states of high arousal could activate atypical defence responses in the body and brain - with PNES being an unwanted by-product of this process. Patients and their families made good use of therapeutic interventions. A total of 75% of children/adolescents (45/60) regained normal function and attained full-time return to school. Global Assessment of Functioning scores increased from 41 to 67 ( t(54) = 10.09; p < .001). Outcomes were less favourable in children/adolescents who presented with chronic PNES and in those with a chronic, comorbid mental health disorder that failed to resolve with treatment. The study highlights that prompt diagnosis, followed by prompt multidisciplinary assessment, engagement, and treatment, achieves improved outcomes in children/adolescents with PNES.
心理性非癫痫性发作（PNES）——意识和运动感觉控制的限时性障碍，脑电图（EEG）上无发作期活动——最好被理解为对情绪困扰、生理应激源和危险的非典型神经生理反应。患者及其家属发现PNES的诊断难以理解；从神经科（做出诊断的科室）到精神卫生服务机构（患者被转诊至该机构接受治疗）的过渡可能会很坎坷。本研究报告了为60例连续的患有PNES的儿童和青少年构建的诊断表述如何用于向他们及其家属解释PNES以及用于帮助患者控制PNES的临床干预措施。当解释了情绪困扰、疾病和高度唤醒状态如何激活身体和大脑中的非典型防御反应——PNES是这一过程中不必要的副产品——时，家属能够接受PNES的诊断并参与治疗。患者及其家属很好地利用了治疗干预措施。共有75%的儿童/青少年（45/60）恢复了正常功能并全日制返校。功能总体评定量表得分从41提高到67（t(54) = 10.09；p < .001）。患有慢性PNES的儿童/青少年以及患有慢性共病精神障碍且治疗后未缓解的儿童/青少年的预后较差。该研究强调，对于患有PNES的儿童/青少年，及时诊断，随后进行及时的多学科评估、参与和治疗，可取得更好的预后。
