Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada.
Epilepsy Behav. 2021 Jul;120:108004. doi: 10.1016/j.yebeh.2021.108004. Epub 2021 May 10.
To identify predictors of Psychogenic NonEpileptic Seizure (PNES) improvement and anti-seizure medication (ASM) discontinuation in patients with PNES only.
This is a retrospective study of a consecutively enrolled cohort of 271 patients diagnosed with PNES by video-EEG (vEEG) telemetry in our Epilepsy Monitoring Unit (EMU) between May 2000 and February 2010. Patients with any possibility of past or present comorbid epilepsy based on clinical, EEG, and neuroimaging, or less than one year of follow-up after discharge were excluded.
A total of 109 subjects were included. The mean age at PNES onset was 33 (range 6-89), mean age at EMU admission was 38.3 (16-89.8), 70.6% were female mean video-EEG length was 6.1 days, and the median time of final follow-up 3.3 (CI 1.6-6.4) years. 51/108 patients (47.2%) reported a PNES decrease and 29 (26.8%) experienced PNES resolution. 59/73 (81.9%) subjects on ASM at the time of EMU admission were able to discontinue them by the final visit. On univariate analysis, patients whose PNES frequency improved were significantly younger at time of admission, more likely married or cohabiting, less likely unemployed, less likely to have migraine, and had a higher frequency of PNES. On hierarchical regression analysis, younger age and employment remained significant predictors of PNES improvement and resolution. Patients who achieved ASM discontinuation had significantly more children and subsequent EMU visits, were less likely to have history of minor head trauma immediately preceding PNES onset and structural brain lesions, experienced a greater reduction of ASMs during the EMU admission, and had a greater improvement of their PNES frequency at the final visit (p ≤ 0.05). On hierarchical regression analysis, higher number of children, absence of structural brain lesions, fewer ASMs at EMU discharge, and improvement of PNES frequency remained significant predictors of ASM discontinuation.
The outcome of PNES is positively correlated with earlier age of diagnosis in an EMU, especially in patients with better social resources. Furthermore, discontinuation of ASM is more likely if the process is initiated during the EMU stay and in the absence of structural brain lesions.
确定仅患有精神性非癫痫性发作（PNES）的患者中，PNES 改善和抗癫痫药物（ASM）停药的预测因素。
这是一项回顾性研究，纳入了 2000 年 5 月至 2010 年 2 月期间在我们的癫痫监测单元（EMU）通过视频-脑电图（vEEG）遥测诊断为 PNES 的连续入组队列的 271 名患者。基于临床、脑电图和神经影像学检查，排除了任何过去或现在合并癫痫的可能性，或出院后随访时间少于 1 年的患者。
共纳入 109 例患者。PNES 发病的平均年龄为 33 岁（范围 6-89 岁），EMU 入院时的平均年龄为 38.3 岁（16-89.8 岁），70.6%为女性，平均视频-脑电图时长为 6.1 天，中位最终随访时间为 3.3 年（置信区间 1.6-6.4 年）。108 例患者中有 51 例（47.2%）报告 PNES 减少，29 例（26.8%）PNES 缓解。EMU 入院时 73 例患者中有 59 例（81.9%）正在服用 ASM，最终就诊时能够停药。单因素分析显示，PNES 发作频率改善的患者入院时年龄较小，更有可能已婚或同居，失业的可能性较小，偏头痛的可能性较小，PNES 发作的频率较高。分层回归分析显示，年龄较小和就业状况仍然是 PNES 改善和缓解的显著预测因素。达到 ASM 停药的患者有更多的孩子，随后的 EMU 就诊次数更多，PNES 发作前无近期轻微头部外伤和结构性脑损伤史，EMU 住院期间 ASM 用量减少更多，最终就诊时 PNES 发作频率改善更大（p 值均≤0.05）。分层回归分析显示，孩子数量较多、无结构性脑损伤、EMU 出院时 ASM 用量较少、PNES 发作频率改善是 ASM 停药的显著预测因素。
EMU 中 PNES 的预后与更早的诊断年龄呈正相关，尤其是在社会资源更好的患者中。此外，如果在 EMU 住院期间开始并排除结构性脑损伤，更有可能停用 ASM。
