AP-HP, Epilepsy Unit and Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France.
Sorbonne Université, Paris, France.
Eur J Neurol. 2021 Aug;28(8):2775-2779. doi: 10.1111/ene.14941. Epub 2021 Jun 20.
Psychogenic non-epileptic seizure-status (PNES-status), defined by psychogenic non-epileptic seizures (PNES) over 30 min, are often misdiagnosed as status epilepticus. We aimed to describe the features of patients who experienced PNES-status, admitted to an intensive care unit (ICU).
We screened the patients hospitalized in our epilepsy unit during a 4-year period, with a diagnosis of PNES-status and ICU admission.
Among 171 patients with PNES, we identified 25 patients (15%) who presented 39 episodes of PNES-status leading to ICU admission. Some 76% of the patients were women. The median age at the time of the PNES-status episode was 35 years. Half (48%) alleged a history of epilepsy, but epilepsy was confirmed in only 12%. A history of psychiatric disease was found in 68%. PNES were present in 85% of patients before PNES-status, and semiology of PNES and PNES-status was similar for 79% of the patients, including hyperkinetic movements in 95% of the episodes and suspected loss of consciousness in 87%. Benzodiazepines were administrated in 77% of the episodes, antiepileptic drugs in 87%, and antibiotherapy for a ICU-related infection in 15% of the episodes. Oral intubation was performed in 41% of the episodes. Blood tests showed normal levels of creatine phosphokinase and leucocytes in 90% and 95% of the episodes, respectively. No epileptic activity was found during per-event electroencephalography but interictal epileptic activity was found in 10% of the episodes.
Hyperkinetic PNES-status should always be considered as a differential diagnosis of status epilepticus, with a high risk of iatrogenic consequences.
由非癫痫性精神发作（PNES）引起的发作持续状态（PNES-status）定义为发作持续 30 分钟以上，常被误诊为癫痫持续状态。我们旨在描述在重症监护病房（ICU）住院的经历 PNES-status 的患者的特征。
我们筛选了在 4 年期间在我们的癫痫病房住院的患者，诊断为 PNES-status 并收入 ICU。
在 171 名患有 PNES 的患者中，我们确定了 25 名患者（15%）出现了 39 次导致 ICU 入院的 PNES-status 发作。约 76%的患者为女性。PNES-status 发作时的中位年龄为 35 岁。有一半（48%）声称有癫痫病史，但仅在 12%的患者中得到证实。68%的患者有精神疾病史。在 PNES-status 发作之前，85%的患者存在 PNES，79%的患者的 PNES 和 PNES-status 表现相似，包括 95%的发作中有运动过度，87%的发作中疑似意识丧失。77%的发作中给予了苯二氮䓬类药物，87%的发作中给予了抗癫痫药物，15%的发作中给予了 ICU 相关感染的抗生素治疗。41%的发作中进行了经口气管插管。90%和 95%的发作中，肌酸磷酸激酶和白细胞的血液检测分别显示正常水平。在每个事件的脑电图检查中均未发现癫痫活动，但在 10%的发作中发现了发作间期的癫痫活动。
应始终将高能量的 PNES-status 视为癫痫持续状态的鉴别诊断，存在医源性后果的高风险。
