Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany.
Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany.
Epilepsia. 2020 Sep;61(9):1931-1938. doi: 10.1111/epi.16629. Epub 2020 Jul 26.
To determine the utility of suggestive seizure induction for inpatient work-up of suspected psychogenic nonepileptic seizures (PNES).
Prospective study of epilepsy center inpatient admissions with suspected PNES. Patients were randomized to undergo suggestive induction first (group A) and then, if necessary, long-term video-electroencephalography (EEG) monitoring, or vice versa (group B). Diagnostic pathways were compared. Potential clinical predictors for diagnostic success were evaluated.
Length of in-hospital stay did not significantly differ between groups. Suspicion of PNES was confirmed in 43 of 77 (56%) patients, evenly distributed between group A (22 of 39) and group B (21 of 38). In nine patients, recorded habitual seizures were epileptic and in 25 cases, no diagnostic event could be recorded. Diagnosis of PNES was ascertained primarily by recording a typical seizure through suggestive induction in 24 patients and through long-term monitoring in 19 patients. In group A (induction first), monitoring was not deemed necessary in 21% of cases. In group B (monitoring first), 13% would have remained inconclusive without suggestive induction. Patients who reported triggers to their habitual seizures were not more likely to have spontaneous or provoked PNES during monitoring or suggestive inducion, respectively. Patients with subjective seizure prodromes (auras) were significantly more likely to have a PNES during suggestive induction than those without (odds ratio [OR] 3.4, 95% confidence interval [CI] 1.1-10.4). There was no significant difference in seizure frequency between patients with spontaneous PNES during long-term monitoring and those with nondiagnostic monitoring sessions.
Our results support the notion that suggestive seizure induction can reduce the number of inconclusive inpatient workups, and can obviate resource-intensive long-term monitoring in one fifth of cases. Patients who are aware of prodromes might have a higher chance of having seizures induced through suggestion.
确定暗示性癫痫发作诱导在疑似心因性非癫痫性发作（PNES）住院患者检查中的作用。
对疑似 PNES 的癫痫中心住院患者进行前瞻性研究。患者随机分为先进行暗示性诱导（A 组），如果必要，然后进行长期视频-脑电图（EEG）监测，或者反之（B 组）。比较诊断途径。评估潜在的临床预测因素对诊断成功的影响。
两组患者的住院时间无显著差异。43 例（56%）患者确诊为疑似 PNES，A 组（39 例中的 22 例）和 B 组（38 例中的 21 例）分布均匀。9 例患者记录的习惯性发作是癫痫性的，25 例患者无诊断性事件可记录。通过暗示性诱导记录到典型发作，从而确定了 24 例患者的 PNES 诊断，通过长期监测确定了 19 例患者的 PNES 诊断。在 A 组（先诱导）中，21%的病例认为不需要监测。在 B 组（先监测）中，如果没有暗示性诱导，有 13%的病例仍无法明确诊断。报告习惯性发作有触发因素的患者，在监测或暗示性诱导期间，自发性或诱发性 PNES 的可能性并不更高。有主观癫痫前驱症状（先兆）的患者在暗示性诱导期间发生 PNES 的可能性明显高于无先兆者（比值比[OR]3.4，95%置信区间[CI]1.1-10.4）。在长期监测期间有自发性 PNES 的患者与监测无诊断性结果的患者之间，发作频率无显著差异。
我们的结果支持这样一种观点，即暗示性癫痫发作诱导可以减少不确定的住院检查数量，并使五分之一的病例无需进行资源密集型的长期监测。有前驱症状的患者通过暗示发生癫痫的可能性更高。
