EEG and Epilepsy Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
EEG and Epilepsy Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Epilepsy Behav. 2020 Oct;111:107145. doi: 10.1016/j.yebeh.2020.107145. Epub 2020 Jul 18.
We aimed to estimate the frequency of epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES) with atypical duration in our epilepsy monitoring unit (EMU), in order to raise awareness of atypical durations of both types of events.
MATERIALS & METHODS: We retrospectively reviewed all consecutive video-electroencephalogram (vEEG) recordings in our medical center's EMU from January 2013 to December 2017 and identified patients with seizures with atypical duration. Short PNES were defined as those lasting fewer than 2 min and long ES as those lasting for more than 5 min.
The files of 830 adult (age >16 years) patients were reviewed, of whom 26 patients (3.1%, mean age: 33.3 ± 9.8 years, 12 females) were diagnosed as having an unusual seizure duration. Among 432 patients with ES during monitoring, fourteen patients [3.2% (95% confidence interval (CI): 1.5%-5.0%), mean age: 33.0 ± 12.2, 5 females [had long ES durations (exceeding 5 min). In 64% of patients with long ES, the events were provoked by antiepileptic drug (AED) withdrawal during vEEG, 62% had focal lesion on brain imaging, and 64% had a frontotemporal or a temporal seizure focus. Among 223 patients diagnosed with PNES, 12 patients [5.4% (95% CI: 2.2%-8.6%), mean age: 33.6 ± 6.6, 7 females] had short PNES durations (less than 2 min) and demonstrated motor (9/12, 75%), altered responsiveness (6/12, 50%), and vocalization (5/12, 42%) as the most prominent clinical features.
The data from our case files highlight two main considerations in the diagnosis of paroxysmal events: prolonged event can be due to ES, while short events can be psychogenic.
我们旨在评估本癫痫监测单元（EMU）中癫痫发作（ES）和非癫痫性精神性发作（PNES）的异常持续时间的频率，以提高对这两种类型事件异常持续时间的认识。
我们回顾性分析了 2013 年 1 月至 2017 年 12 月在本医疗中心 EMU 进行的所有连续视频-脑电图（vEEG）记录，并确定了具有异常持续时间的发作患者。短暂性 PNES 定义为持续时间少于 2 分钟，长发性 ES 定义为持续时间超过 5 分钟。
共回顾了 830 例成人（年龄>16 岁）患者的档案，其中 26 例患者（3.1%，平均年龄：33.3±9.8 岁，女性 12 例）被诊断为具有异常发作持续时间。在监测期间的 432 例 ES 患者中，14 例患者[3.2%（95%置信区间（CI）：1.5%-5.0%），平均年龄：33.0±12.2，女性 5 例]出现长时间 ES 持续时间（超过 5 分钟）。在 64%的长 ES 患者中，事件是在 vEEG 期间抗癫痫药物（AED）撤药引起的，62%的患者在脑部成像上有局灶性病变，64%的患者有额颞部或颞部发作灶。在 223 例诊断为 PNES 的患者中，12 例患者[5.4%（95%CI：2.2%-8.6%），平均年龄：33.6±6.6，女性 7 例]出现短暂 PNES 持续时间（少于 2 分钟），并表现出运动（9/12，75%）、反应改变（6/12，50%）和发声（5/12，42%）作为最突出的临床特征。
我们的病例档案数据强调了诊断阵发性事件时需要考虑的两个主要因素：延长的事件可能是 ES，而短暂的事件可能是精神性的。
