Verducci Chloe, Friedman Daniel, Devinsky Orrin
New York University Comprehensive Epilepsy Center New York New York.
Epilepsia Open. 2019 Jun 6;4(3):482-486. doi: 10.1002/epi4.12342. eCollection 2019 Sep.
We report 13 SUDEP cases in the North American SUDEP Registry with both psychogenic nonepileptic seizures (PNES) and epileptic seizures (ES) among a consecutive series of 231 cases (excluding epileptic encephalopathies). On average, cases of PNES + ES died at a younger age (23 ± 11 years) than the ES-only cohort (30 ± 14 years), and died an average of 3 years after PNES diagnosis. We found no statistically significant confounding cardiac, respiratory, or psychiatric comorbidities and equal rates of anti-seizure medication adherence, although there was a trend for higher rates of psychiatric disorders in the PNES group. Our findings confirm that patients with comorbid ES and PNES can die from SUDEP and that there may be a high-risk period after the diagnosis of PNES is made in patients with comorbid ES. Such patients should be closely monitored and provided with coordinated care of both their epilepsy and psychiatric disorder(s).
我们在北美不明原因癫痫性猝死登记处报告了13例不明原因癫痫性猝死病例，这些病例同时患有精神性非癫痫发作（PNES）和癫痫发作（ES），在连续的231例病例（不包括癫痫性脑病）中。平均而言，患有PNES + ES的病例死亡年龄（23±11岁）比仅患有ES的队列（30±14岁）更小，且在PNES诊断后平均3年死亡。我们发现没有统计学上显著的心脏、呼吸或精神共病混杂因素，且抗癫痫药物依从率相同，尽管PNES组精神障碍发生率有升高趋势。我们的研究结果证实，患有ES和PNES共病的患者可能死于不明原因癫痫性猝死，且在患有ES和PNES共病的患者中，PNES诊断后可能存在高危期。此类患者应密切监测，并给予癫痫和精神障碍的协调护理。
