Viarasilpa Tanuwong, Panyavachiraporn Nicha, Osman Gamaleldin, Akioyamen Noel O, Wasade Vibhangini S, Barkley Gregory, Mayer Stephan A
Department of Neurology, Henry Ford Hospital (TV, NP, GO, NOA, VSW, GB, SAM), Detroit, MI, USA; Division of Critical Care, Department of Medicine, Siriraj Hospital, Mahidol University (TV, NP), Bangkok, Thailand.
Seizure. 2019 Dec 31;76:17-21. doi: 10.1016/j.seizure.2019.12.025.
Patients with psychogenic non-epileptic attacks (PNEA) sometimes receive aggressive treatment leading to endotracheal intubation. We sought to identify the frequency, risk factors, and impact on outcome of intubation for PNEA.
We retrospectively reviewed all PNEA patients admitted via the emergency department (ED) who had an episode of PNEA documented by continuous video electroencephalography (vEEG) at Henry Ford Hospital between January 2012 and October 2017. Patients with comorbid epilepsy were excluded. Clinical features, treatments, and vEEG reports were compared between intubated and non-intubated patients.
Of 80 patients who were admitted via the ED and had PNEA documented by vEEG, 12 (15%) were intubated. Compared with non-intubated PNEA patients, intubated patients had longer duration of convulsive symptoms (25 [IQR 7-53] vs 2 [IQR 1-9] minutes, P = 0.01), were less likely to have a normal Glasgow Coma Scale score of 15 (33% vs 94%, P < 0.001), received higher doses of benzodiazepines (30 [IQR 16-45] vs 10 [IQR 5-20] mg of diazepam equivalents, P = 0.004), and were treated with more antiepileptic drugs (AEDs, 2 [IQR 1-3] vs 1 [IQR 1-2], P = 0.01). Hospital length of stay was longer (3 [IQR 3-5] vs 2 [IQR 2-3], P = 0.001), and the rate of complications (25% vs 4%, P = 0.04) and re-hospitalization from a recurrent episode of PNEA within 30 days was higher among intubated PNEA patients (17% vs 0%, P = 0.02).
Fifteen percent of patients hospitalized for vEEG-documented PNEA were intubated. Intubated patients had longer length of stay, more in-hospital complications, and a high rate of re-hospitalization from recurrent PNEA symptoms. Prolonged duration of convulsive symptoms, depressed level of consciousness, and aggressive treatment with benzodiazepines were associated with intubation for PNEA.
心因性非癫痫性发作（PNEA）患者有时会接受激进治疗，甚至导致气管插管。我们试图确定PNEA患者气管插管的频率、危险因素及其对预后的影响。
我们回顾性分析了2012年1月至2017年10月期间在亨利·福特医院急诊科收治的所有经连续视频脑电图（vEEG）记录有PNEA发作的患者。排除合并癫痫的患者。比较插管患者与未插管患者的临床特征、治疗方法及vEEG报告。
在80例经急诊科收治且经vEEG记录有PNEA发作的患者中，12例（15%）接受了气管插管。与未插管的PNEA患者相比，插管患者的惊厥症状持续时间更长（25[四分位间距7 - 53]分钟 vs 2[四分位间距1 - 9]分钟，P = 0.01），格拉斯哥昏迷量表评分为15分的可能性更小（33% vs 94%，P < 0.001），接受苯二氮䓬类药物的剂量更高（30[四分位间距16 - 45] vs 10[四分位间距5 - 20]mg地西泮等效剂量，P = 0.004），且接受更多抗癫痫药物治疗（AEDs，2[四分位间距1 - 3] vs 1[四分位间距1 - 2]，P = 0.01）。住院时间更长（3[四分位间距3 - 5]天 vs 2[四分位间距2 - 3]天，P = 0.001），插管的PNEA患者并发症发生率更高（25% vs 4%，P = 0.04），且30天内因PNEA复发再次住院的比例更高（17% vs 0%，P = 0.02）。
因vEEG记录的PNEA住院的患者中，15%接受了气管插管。插管患者住院时间更长，院内并发症更多，且因PNEA复发再次住院的比例较高。惊厥症状持续时间延长、意识水平降低以及苯二氮䓬类药物的激进治疗与PNEA患者的气管插管有关。
