Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany.
J Neurol Neurosurg Psychiatry. 2021 Dec;92(12):1341-1345. doi: 10.1136/jnnp-2021-326443. Epub 2021 Aug 6.
To determine the epidemiology of prolonged psychogenic non-epileptic seizures (pPNES) misdiagnosed as status epilepticus, as well as the risks associated with non-indicated treatment.
We performed an individual patient data analysis from the Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART) and the Established Status Epilepticus Treatment Trial (ESETT) to assess incidence, patient characteristics and clinical course of misdiagnosed pPNES.
Among 980 patients aged 8 years or older diagnosed and treated for status epilepticus in RAMPART and ESETT, 79 (8.1%) were discharged with a final diagnosis of pPNES. The relative incidence was highest in adolescents and young adults (20.1%). The typical female preponderance seen in that age bracket was not evident in children and older adults. Adverse effects, including respiratory depression and intubation, were documented in 26% of patients with pPNES receiving benzodiazepines in RAMPART and 33% of patients receiving additional second-line medication in ESETT. In ESETT, patients who were treated with benzodiazepines before hospital admission had higher rates of unresponsiveness and severe adverse effects than those treated after admission, suggesting cumulative effects of accelerated treatment momentum. Across trials, one in five patients with pPNES were admitted to an intensive care unit.
Misdiagnosis and treatment of pPNES as status epilepticus are a common and widespread problem with deleterious consequences. Mitigating it will require training of emergency staff in semiological diagnosis. Status epilepticus response protocols should incorporate appropriate diagnostic re-evaluations at each step of treatment escalation, especially in clinical trials.
确定被误诊为癫痫持续状态的延长性心因性非癫痫性发作（pPNES）的流行病学，以及与非指征治疗相关的风险。
我们对 Rapid Anticonvulsant Medication Prior to Arrival Trial（RAMPART）和 Established Status Epilepticus Treatment Trial（ESETT）中的个体患者数据进行了分析，以评估误诊为 pPNES 的病例发生率、患者特征和临床过程。
在 RAMPART 和 ESETT 中，980 例年龄在 8 岁或以上的被诊断和治疗为癫痫持续状态的患者中，有 79 例（8.1%）出院时的最终诊断为 pPNES。相对发病率在青少年和年轻成年人中最高（20.1%）。在该年龄段中常见的女性优势在儿童和老年人中并不明显。在 RAMPART 中接受苯二氮䓬类药物治疗的 26%和 ESETT 中接受额外二线药物治疗的 33%的 pPNES 患者记录到了不良反应，包括呼吸抑制和插管。在 ESETT 中，在入院前接受苯二氮䓬类药物治疗的患者无反应和严重不良反应的发生率高于入院后接受治疗的患者，提示加速治疗势头的累积效应。在两项试验中，有五分之一的 pPNES 患者被收入重症监护病房。
将 pPNES 误诊为癫痫持续状态是一个常见且广泛存在的问题，会带来有害后果。减少这种误诊需要对急救人员进行半定量诊断方面的培训。癫痫持续状态的治疗方案应在治疗升级的每个步骤中纳入适当的诊断重新评估，尤其是在临床试验中。
