Chen David K, Majmudar Shirine, Ram Aarthi, Rutherford Holly C, Fadipe Melissa, Dunn Callie B, Collins Robert L
Peter Kellaway Section of Neurophysiology, Department of Neurology, Baylor College of Medicine, Houston, TX, USA; Neurology Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
Epilepsy Behav. 2018 Jun;83:186-191. doi: 10.1016/j.yebeh.2018.03.007. Epub 2018 Apr 27.
We aimed to evaluate whether potential changes in the patient's illness perception can significantly influence short-term seizure burden following video-electroencephalography (EEG) confirmation/explanation of psychogenic nonepileptic seizures (PNES).
Patients with PNES were dichotomized to two groups based on a five-point Symptom Attribution Scale: (a) those who prior to diagnosis perceived their seizures to be solely ("5") or mainly ("4") physical in origin (physical group) and (b) the remainder of patients with PNES (psychological group). The physical group (n=32), psychological group (n=40), and group with epilepsy (n=26) also completed the Brief Illness Perception Questionnaire (BIPQ) prior to diagnosis, and were followed up at 3months as well as at 6months postdiagnosis.
At 3months postdiagnosis, the physical group experienced significantly greater improvement in seizure intensity (p=0.002) and seizure frequency (p=0.016) when compared with the psychological group. The physical group was significantly more likely to have modified their symptom attribution toward a greater psychological role to their seizures (p=0.002), and their endorsement on the BIPQ item addressing "consequences" (How much do your seizures affect your life?) was significantly less severe (p'=0.014) when compared with that of the psychological group and the group with epilepsy. At 6months postdiagnosis, the physical group continued to experience significantly greater improvement in seizure intensity (p=0.007) while their seizure frequency no longer reached significant difference (p=0.078) when compared with the psychological group. The physical group continued to be significantly more likely to have modified their symptom attribution toward a greater psychological role to their seizures (p=0.005), and their endorsement on the BIPQ item addressing "consequences" remained significantly less severe (p'=0.037) when compared with the psychological group and the group with epilepsy.
Among patients with PNES, prediagnosis perception of seizures as "solely" or "mainly" physical in cause may be associated with greater likelihood of early postdiagnosis improvement in seizure burden. Within this physical group postdiagnosis, we uncovered preliminary evidence for significantly greater attribution toward psychological roles in seizures as well as reduction in cognitive distortion surrounding the adverse consequences of seizures. These findings portend particular impact of such changes in illness perception for this group.
我们旨在评估患者疾病认知的潜在变化是否会显著影响在视频脑电图（EEG）确诊/解释为精神性非癫痫性发作（PNES）后的短期癫痫发作负担。
根据五点症状归因量表将PNES患者分为两组：（a）在诊断前认为其发作完全（“5”）或主要（“4”）源于身体因素的患者（身体因素组），以及（b）其余PNES患者（心理因素组）。身体因素组（n = 32）、心理因素组（n = 40）和癫痫组（n = 26）在诊断前还完成了简易疾病认知问卷（BIPQ），并在诊断后3个月和6个月进行随访。
在诊断后3个月，与心理因素组相比，身体因素组在癫痫发作强度（p = 0.002）和发作频率（p = 0.016）方面有显著更大的改善。身体因素组更有可能将其症状归因向癫痫发作的心理作用更大程度地转变（p = 0.002），并且与心理因素组和癫痫组相比，他们在BIPQ中关于“后果”（你的癫痫发作对你的生活有多大影响？）这一项目上的认同明显不那么严重（p' = 0.014）。在诊断后6个月，与心理因素组相比，身体因素组在癫痫发作强度方面继续有显著更大的改善（p = 0.007），而其发作频率不再有显著差异（p = 0.078）。身体因素组继续更有可能将其症状归因向癫痫发作的心理作用更大程度地转变（p = 0.005），并且与心理因素组和癫痫组相比，他们在BIPQ中关于“后果”这一项目上的认同仍然明显不那么严重（p' = 0.037）。
在PNES患者中，诊断前将发作“完全”或“主要 ”归因于身体因素可能与诊断后早期癫痫发作负担改善的可能性更大相关。在这个身体因素组诊断后，我们发现了初步证据，表明对癫痫发作的心理作用有明显更大的归因，以及围绕癫痫发作不良后果的认知扭曲减少。这些发现预示着疾病认知的这种变化对该组有特别的影响。
