Sagi Vishwanath, Shoup Jaime, Chilukuri Ravikiran, Evans M Steven
Drs. Sagi and Evans are with the Department of Neurology at the University of Louisville in Louisville, Kentucky.
Dr. Shoup and Mr. Chilukuri are with the University of Louisville School of Medicine in Louisville, Kentucky.
Innov Clin Neurosci. 2020 Jul 1;17(7-9):26-29.
The objective was to study latency to first event among patients with psychogenic nonepileptic seizures compared (PNES) to epileptic seizures (ES) in an epilepsy monitoring unit (EMU). PNES are common imitators of ES. This study investigates latency to first event in patients with PNES compared to patients with ES. We performed a retrospective chart review of patients admitted to our EMU from March 2016 to October 2017. We identified patients with PNES and ES. Patients with other nonepileptic events and mixed PNES (epilepsy plus PNES) were excluded. Patient demographics, baseline seizure frequency, length of EMU stay and time from admission to first event were recorded. In total, 111 patients with PNES and 121 patients with ES were included. The mean age (in years) was 42 and 38, respectively. The average baseline seizure frequency was four times higher in the PNES group than the ES group. Greater than half (52%) of the patients with PNES and about one third (38%) of the patients with ES had an event within the first 24 hours. The average time to first event was 20.88 hours for the PNES group and 30.99 hours for the ES group (<0.01). The median latency to first event was 14 hours for the PNES group and 23 hours for the ES group. The average length of EMU stay was significantly longer in the ES group (70.82 hours) than the PNES group (53.95 hours). The average time to first event is shorter for PNES than in ES. In patients with high pre-EMU clinical suspicion for PNES, relatively shorter EMU monitoring (24 to 48 hours) can confirm diagnosis. This phenomenon might improve cost-effectiveness of EMU monitoring in patients with PNES.
目的是在癫痫监测单元（EMU）中，研究与癫痫发作（ES）患者相比，精神性非癫痫性发作（PNES）患者首次发作的延迟时间。PNES是ES常见的模仿者。本研究调查了PNES患者与ES患者首次发作的延迟时间。我们对2016年3月至2017年10月入住我们EMU的患者进行了回顾性病历审查。我们确定了PNES患者和ES患者。排除了患有其他非癫痫性事件和混合性PNES（癫痫加PNES）的患者。记录了患者的人口统计学信息、基线癫痫发作频率、EMU住院时间以及从入院到首次发作的时间。总共纳入了111例PNES患者和121例ES患者。平均年龄（岁）分别为42岁和38岁。PNES组的平均基线癫痫发作频率比ES组高四倍。超过一半（52%）的PNES患者和约三分之一（38%）的ES患者在最初24小时内发生了事件。PNES组首次发作的平均时间为20.88小时，ES组为30.99小时（<0.01）。PNES组首次发作的中位延迟时间为14小时，ES组为23小时。ES组的EMU平均住院时间（70.82小时）明显长于PNES组（53.95小时）。PNES患者首次发作的平均时间比ES患者短。对于EMU前临床高度怀疑为PNES的患者，相对较短的EMU监测（24至48小时）即可确诊。这种现象可能会提高EMU对PNES患者监测的成本效益。
