癫痫发作与心因性癫痫样发作中刻板行为的系统研究。
A systematic study of stereotypy in epileptic seizures versus psychogenic seizure-like events.
作者信息
Vogrig Alberto, Hsiang Jen Chun, Ng Jacqueline, Rolnick Joshua, Cheng Jessica, Parvizi Josef
机构信息
Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.
Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.
出版信息
Epilepsy Behav. 2019 Jan;90:172-177. doi: 10.1016/j.yebeh.2018.11.030. Epub 2018 Dec 20.
OBJECTIVE
The objective of this study was to quantify the features of stereotypy in epileptic seizures and compare it with that of stereotypy in psychogenic nonepileptic seizure-like events (PNES) confirmed by video-electroencephalography (VEEG) monitoring.
METHODS
Video-electroencephalography monitoring records of 20 patients with temporal lobe seizures (TLS) and 20 with PNES were retrospectively reviewed (n = 138 seizures, 48 TLS and 90 PNES). We analyzed the semiology of 59 behaviors of interest for their presence, duration, sequence, and continuity using quantified measures that were entered into statistical analysis.
RESULTS
We identified discontinuity as the parameter that was clearly distinct between PNES and epileptic TLS events: there were significantly more frequent pauses of behavior (i.e., "on-off" pattern) in PNES compared with TLS (P = 0.012). The frequency of pauses during an event was diagnostic of PNES events. For instance, the presence of 2 "pauses" during an episode determines a 69% probability of the seizure being nonepileptic. Moreover, PNES events had significantly greater duration (143 s) than TLS events (68 s) (excluding outliers, P = 0.002) and greater duration variability from one event to another in the same subject (P = 0.005).
SIGNIFICANCE
Our work provides the first quantified measure of behavioral semiology during epileptic and nonepileptic seizures and offers novel behavioral measures to differentiate them from each other.
目的
本研究的目的是量化癫痫发作中刻板行为的特征，并将其与视频脑电图（VEEG）监测确诊的精神性非癫痫性发作样事件（PNES）中的刻板行为特征进行比较。
方法
回顾性分析20例颞叶癫痫（TLS）患者和20例PNES患者的视频脑电图监测记录（共138次发作，其中48次TLS发作和90次PNES发作）。我们使用量化指标分析了59种感兴趣行为的症状学，包括行为的存在、持续时间、顺序和连续性，并将这些指标纳入统计分析。
结果
我们确定行为间断性是PNES与癫痫性TLS事件之间明显不同的参数：与TLS相比，PNES中行为暂停（即“开-关”模式）更为频繁（P = 0.012）。事件期间的暂停频率可用于诊断PNES事件。例如，一次发作中出现2次“暂停”，则该发作非癫痫性的概率为69%。此外，PNES事件的持续时间（143秒）明显长于TLS事件（68秒）（排除异常值，P = 0.002），且同一受试者不同事件之间的持续时间变异性更大（P = 0.005）。
意义
我们的研究首次对癫痫性发作和非癫痫性发作期间的行为症状学进行了量化测量，并提供了新的行为测量方法以区分二者。
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