University of Melbourne, Department of Psychiatry, Austin Health, Heidelberg, VIC, 3084, Australia.
Department of Neurology, Austin Health, Heidelberg, VIC, 3084, Australia; The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, 3084, Australia.
Seizure. 2018 Jul;59:108-115. doi: 10.1016/j.seizure.2018.05.007. Epub 2018 May 19.
Psychogenic Non-Epileptic Seizures (PNES) are events that appear epileptic but are instead thought to have a psychological origin. Increased rates of several psychiatric disorders have been reported in PNES, including anxiety and panic disorders. Some theories suggest panic and/or hyperventilation have aetiological roles in PNES, though these remain unproven.
We conducted a systematic review of associations of panic and hyperventilation with PNES using Ovid Medline and PubMed, and a meta-analysis where appropriate.
We found eighteen studies reporting rates of panic in PNES and eight studies reporting hyperventilation. The reported rate of panic attacks in PNES ranged from 17% to 83%, with physical symptoms more commonly reported, and affective symptoms less so. 'Dizziness or light-headedness' was found to be more prevalent than 'fear of dying' by random-effects meta-analysis (68% vs. 23%). A proportion meta-analysis found a weighted occurrence of 20% of panic disorder in PNES. A pooled meta-analytic rate of PNES events following voluntary hyperventilation induction was 30%, while the clinically observed rates of peri-ictal hyperventilation in PNES without induction varied from 15 to 46%.
Previous studies have reported moderate rates of association of panic in PNES, though the proportions varied considerably across the literature, with physical symptoms more commonly reported than affective. Hyperventilation is an effective inducer of PNES events in a minority, and can be observed occurring in a minority of patients without induction. These results support an important, albeit not essential, role for panic and hyperventilation in the pathogenesis of PNES events.
心因性非癫痫性发作（PNES）是一种表现为癫痫样但被认为具有心理起源的事件。PNES 中已报道多种精神障碍的发生率增加，包括焦虑症和惊恐障碍。一些理论表明惊恐和/或过度通气在 PNES 中有病因作用，但这些仍未得到证实。
我们使用 Ovid Medline 和 PubMed 对惊恐和过度通气与 PNES 的关联进行了系统综述，并在适当的情况下进行了荟萃分析。
我们发现了 18 项报告 PNES 中惊恐发作率的研究和 8 项报告过度通气的研究。PNES 中惊恐发作的报告率从 17%到 83%不等，更常见的是躯体症状，而情感症状较少。随机效应荟萃分析发现，“头晕或头晕”比“害怕死亡”更为普遍（68%对 23%）。比例荟萃分析发现，PNES 中惊恐障碍的加权发生率为 20%。自愿过度通气诱导后 PNES 事件的汇总荟萃分析发生率为 30%，而无诱导时 PNES 中peri-ictal 过度通气的临床观察发生率从 15%到 46%不等。
以前的研究报告了惊恐与 PNES 中度相关的比例，尽管文献中的比例差异很大，躯体症状比情感症状更常见。过度通气在少数人中是 PNES 事件的有效诱导剂，并且在没有诱导的情况下也可以观察到少数患者发生过度通气。这些结果支持惊恐和过度通气在 PNES 事件发病机制中具有重要但不是必要的作用。
