Department of Neurosciences, Hospital Germans Trias i Pujol, C/Canyet s/n, 08916 Badalona, Spain.
Department of Neurosciences, Hospital Germans Trias i Pujol, C/Canyet s/n, 08916 Badalona, Spain.
Epilepsy Behav. 2021 Apr;117:107766. doi: 10.1016/j.yebeh.2020.107766. Epub 2021 Feb 12.
Much remains to be elucidated about the cognitive profile of patients with psychogenic nonepileptic seizures (PNES) and about how this changes over time and compares to that of patients with epilepsy. The aim of this study was to study the neuropsychological profile of patients with PNES and an age-matched group of patients with temporal lobe epilepsy (TLE) during admission to a video electroencephalography monitoring unit (VEMU) and 1 year after discharge.
Patients diagnosed with PNES or TLE at a VEMU were prospectively recruited. Neuropsychological, demographic, clinical, and treatment variables were collected at baseline and 1 year. To minimize multiple comparisons, scores from different cognitive tests were computed for attention and psychomotor speed, verbal memory, visual memory, language, and executive function. A global cognitive impairment index (GCII) was also created. Post hoc analyses were conducted to identify clinical variables that might mediate the differences observed in cognition over time between the groups. These included seizure frequency, number of antiseizure medication (ASM), number of psychotropic drugs, depression, and quality of life.
We studied 24 patients with PNES and 24 patients with TLE. The groups performed similarly in the baseline neuropsychological tests. There was a significant time (baseline to 1-year follow-up) by group (PNES vs TLE) interaction for the GCII (p = 0.006), language (p = 0.04), and executive function (p = 0.013), with PNES patients showing improvement and TLE patients remaining stable. The time by group interaction for attention and psychomotor speed showed a trend toward significance (p = 0.056), Reduction in number of ASM was associated with improved cognition in PNES patients at 1 year.
PNES patients showed improved cognition at 1 year of follow-up, particularly in language and executive functions. This finding shows the potential benefits of an early, accurate diagnosis, which range from improved cognition to better management.
关于心因性非癫痫性发作（PNES）患者的认知特征，以及这种特征如何随时间变化以及与癫痫患者的认知特征相比，仍有许多需要阐明。本研究的目的是在视频脑电图监测病房（VEMU）入院期间和出院后 1 年，研究 PNES 患者和年龄匹配的颞叶癫痫（TLE）患者的神经心理学特征。
前瞻性招募在 VEMU 诊断为 PNES 或 TLE 的患者。在基线和 1 年时收集神经心理学、人口统计学、临床和治疗变量。为了尽量减少多重比较，从不同认知测试中计算注意力和运动速度、言语记忆、视觉记忆、语言和执行功能的分数。还创建了一个总体认知损伤指数（GCII）。进行事后分析以确定可能在两组之间随时间观察到的认知差异中起中介作用的临床变量。这些变量包括癫痫发作频率、抗癫痫药物（ASM）数量、精神药物数量、抑郁和生活质量。
我们研究了 24 例 PNES 患者和 24 例 TLE 患者。两组在基线神经心理学测试中表现相似。GCII（p=0.006）、语言（p=0.04）和执行功能（p=0.013）存在显著的时间（基线到 1 年随访）与组（PNES 与 TLE）交互作用，PNES 患者的认知能力有所改善，而 TLE 患者则保持稳定。注意力和运动速度的时间与组间交互作用显示出显著趋势（p=0.056），ASM 数量的减少与 PNES 患者在 1 年内认知能力的提高相关。
PNES 患者在随访 1 年后认知能力有所提高，特别是在语言和执行功能方面。这一发现表明早期、准确的诊断具有潜在的益处，从改善认知到更好的管理。
