Department of Neurology, G.G. Kuvatov Republican Clinical Hospital, Ufa, Russia; Department of Neurology, Bashkir State Medical University, Ufa, Russia.
Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Camperdown, New South Wales, Australia.
Epilepsy Behav. 2018 Dec;89:70-78. doi: 10.1016/j.yebeh.2018.10.010. Epub 2018 Oct 29.
Comorbid epilepsy and psychogenic nonepileptic seizures (PNES) represent a serious challenge for the clinicians. However, the frequency, associations, and outcomes of dual diagnosis of epilepsy and PNES are unclear. The aim of the review was to determine the frequency, correlates, and outcomes of a dual diagnosis. A systematic review of all published observational studies (from inception to Dec. 2016) was conducted to determine the frequency, correlates, and outcomes of dual diagnosis. We included studies of individuals of any age reporting a dual diagnosis of epilepsy and PNES. All observational study designs were included with the exception of case reports and case series with fewer than 10 participants. The mean frequency of epilepsy in patients with PNES across all studies was 22% (95% confidence intervals [CI] 20 to 25%, range: 0% to 90%) while the mean frequency of PNES in patients with epilepsy was 12% (95% CI 10 to 14%, range: 1% to 62%). High heterogeneity means that these pooled estimates should be viewed with caution. A number of correlates of dual diagnosis were reported. Some studies delineated differences in semiology of seizures in patients with dual diagnosis vs. PNES or epilepsy only. However, most of the correlates were inconclusive. Only a few studies examined outcome in patients with dual diagnosis. Dual diagnosis is common in clinical practice, especially among patients referred to specialized services, and requires careful diagnosis and management.
共患癫痫和心因性非癫痫性发作（PNES）对临床医生来说是一个严峻的挑战。然而，癫痫和 PNES 双重诊断的频率、关联和结局尚不清楚。本综述的目的是确定癫痫和 PNES 双重诊断的频率、相关性和结局。对所有已发表的观察性研究（从开始到 2016 年 12 月）进行了系统回顾，以确定双重诊断的频率、相关性和结局。我们纳入了报告癫痫和 PNES 双重诊断的任何年龄个体的研究。所有观察性研究设计都包括在内，除了病例报告和少于 10 例参与者的病例系列。所有研究中 PNES 患者癫痫的平均频率为 22%（95%置信区间[CI] 20 至 25%，范围：0%至 90%），而癫痫患者 PNES 的平均频率为 12%（95%CI 10 至 14%，范围：1%至 62%）。高异质性意味着这些汇总估计值应谨慎看待。报告了一些双重诊断的相关性。一些研究描述了双重诊断患者与仅患有 PNES 或癫痫患者的发作症状学差异。然而，大多数相关性尚无定论。只有少数研究检查了双重诊断患者的结局。双重诊断在临床实践中很常见，尤其是在专门服务机构就诊的患者中，需要仔细诊断和管理。
