拉丁美洲的精神性非癫痫性发作：一项描述当前实践的调查。

Psychogenic nonepileptic seizures in Latin America: A survey describing current practices.

机构信息

Epilepsy Program, Hospital Pablo Tobón Uribe, University of Antioquia, Medellín, Colombia.

Neuromédica, Medellín, Colombia.

出版信息

Epilepsy Behav. 2021 Jan;114(Pt A):107150. doi: 10.1016/j.yebeh.2020.107150. Epub 2020 Jun 2.

DOI:10.1016/j.yebeh.2020.107150

PMID:32507294

Abstract

OBJECTIVE

Psychogenic nonepileptic seizures (PNES) are one of the most common differential diagnoses of epilepsy. This study provides an overview of diagnostic and treatment services for patients with PNES across Latin America.

METHODS

In 2017-2018, clinicians practicing in Latin America with responsibilities for patients with PNES were contacted to respond to a survey regarding the management of this disorder developed by the International League Against Epilepsy (ILAE) PNES Task Force.

RESULTS

Three hundred and sixty responses from 17 Latin American countries were analyzed. Most respondents were neurologists (81%) under 40 years of age (61%). Fifty-seven percent of professionals stated that they personally diagnose PNES, but only 33% stated that they provide follow-up, and only 20% that they recommend treatment. Many participants (54%) characterized themselves as either unfamiliar with the diagnosis or inexperienced in arranging treatment. Most respondents reported having access to brain magnetic resonance imaging (MRI; 88%) and routine electroencephalogram (EEG; 71%), 64% have the access to video-EEG longer than 8 h, and 54% of professionals performed video-EEG to confirm PNES diagnoses. Although cognitive-behavioral therapy was recognized as the treatment of choice (by 82% of respondents), there was little access to it (60%). In contrast, a high proportion of respondents reported using antidepressant (67%), antiseizure (57%), and antipsychotic medications (54%) as treatments for PNES.

SIGNIFICANCE

This study reveals several deficiencies in the diagnosis and treatment of patients with PNES in Latin America. The barriers are reinforced by lack of knowledge among the specialists and poor healthcare system support. There is inadequate access to prolonged video-EEG and psychotherapy. An inappropriate use of antiseizure medicines seems commonplace, and there are low follow-up rates by neurologists after the diagnosis. Multidisciplinary guidelines are required to improve the approach of patients with PNES.

摘要

目的

心因性非癫痫性发作（PNES）是癫痫最常见的鉴别诊断之一。本研究概述了拉丁美洲各地 PNES 患者的诊断和治疗服务。

方法

在 2017-2018 年，与拉丁美洲的 PNES 患者管理相关的职责的临床医生被联系以回复由国际抗癫痫联盟（ILAE）PNES 工作组制定的关于该疾病管理的调查。

结果

从 17 个拉丁美洲国家分析了 360 个回复。大多数受访者是年龄在 40 岁以下的神经科医生（81％）。57％的专业人员表示他们亲自诊断 PNES，但只有 33％表示他们提供随访，只有 20％表示他们建议治疗。许多参与者（54％）认为自己不熟悉诊断或不熟悉安排治疗。大多数受访者报告说他们可以获得脑磁共振成像（MRI；88％）和常规脑电图（EEG；71％），64％的人可以获得超过 8 小时的视频脑电图，并且 54％的专业人员进行视频脑电图以确认 PNES 诊断。尽管认知行为疗法被认为是首选治疗方法（82％的受访者），但很少有机会使用它（60％）。相比之下，许多受访者报告说使用抗抑郁药（67％）、抗癫痫药（57％）和抗精神病药（54％）治疗 PNES。