Qiao Liang, Yu Tao, Li Yongjie
Beijing Institute of Functional Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China.
Ann Transl Med. 2021 Feb;9(3):273. doi: 10.21037/atm-20-5423.
Despite common comorbidities of epileptic seizure (ES) and psychogenic nonepileptic seizure (PNES), reports regarding the clinical management of the two coexisting disorders have traditionally only focused on non-surgical approaches such as medication and psychotherapy. Epileptogenic zonectomy following comprehensive presurgical evaluation could lead to seizure control and even seizure free in refractory epilepsy patients. However, its effect on PNES which is of clinical significance remains to be explored. Here, we present a favorable surgical outcome in a middle-aged woman with refractory epilepsy with concomitant video-electroencephalograph-confirmed PNES. The patient has been ES free post right-sided anterior temporal lobectomy with unchanged antiepileptic medication. Meanwhile, remarkable improvement of her PNES has been reported although she did not undergo psychiatric or psychological therapy following surgery. The treatment success achieved in this case suggests that comorbid PNES should not deprive patients with intractable epilepsy patients a chance to undergo surgical intervention if their epileptogenic zones could be identified during presurgical evaluation. Some patients could obtain relieves of both ES and PNES from appropriately performed epilepsy surgery. Nevertheless, the mechanisms underlying the findings in this report are still unknown. Further study is needed to investigate whether epileptogenic zonectomy itself or the patient's positive mood brought by ES control contributes to postoperative alleviation of PNES.
尽管癫痫发作（ES）和精神性非癫痫性发作（PNES）常合并存在，但关于这两种共存疾病临床管理的报告传统上仅侧重于药物治疗和心理治疗等非手术方法。在全面的术前评估后进行致痫区切除术可使难治性癫痫患者的癫痫发作得到控制甚至无发作。然而，其对具有临床意义的PNES的影响仍有待探索。在此，我们报告了一名中年女性难治性癫痫合并视频脑电图证实的PNES患者的良好手术结果。该患者在右侧前颞叶切除术后无癫痫发作，抗癫痫药物未改变。同时，尽管术后未接受精神科或心理治疗，但据报告其PNES有显著改善。该病例取得的治疗成功表明，如果在术前评估中能够识别出致痫区，合并存在的PNES不应剥夺难治性癫痫患者接受手术干预的机会。一些患者可以通过适当进行的癫痫手术同时缓解癫痫发作和PNES。然而，本报告中这些发现的潜在机制仍然未知。需要进一步研究以调查致痫区切除术本身还是癫痫发作控制给患者带来的积极情绪有助于术后PNES的缓解。
