Department of Neurology, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom.
Department of Neurology, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom.
Epilepsy Behav. 2022 Apr;129:108656. doi: 10.1016/j.yebeh.2022.108656. Epub 2022 Mar 16.
Epileptic seizures are well recognized as a presenting symptom in patients with brain tumors, however much less is known about coexisting nonepileptic attack disorder (NEAD) in this population. Establishing a diagnosis of NEAD can be challenging, especially in those with concomitant epilepsy. Nonepileptic attack disorder is associated with a high rate of morbidity, often due to coexisting psychological factors which may require the input of multiple services. In an era where early aggressive management of tumors is enabling patients to live longer, the associated psychological impact of adjusting to physical disease is increasingly apparent. In this case series, we present a narrative summary of 9 patients referred to neurology with brain tumor-related epilepsy (BTRE) over a five-year period (2015-2020) who also experienced NEAD. We describe their tumor characteristics, treatment course, and factors potentially contributing to their presentation. We conducted a case note review of patients presenting to the epilepsy service with BTRE, in whom NEAD was diagnosed based on clinical features and correlation with their EEG. Patients ranged in age from 26 to 63 years. Two patients were diagnosed with grade 1, three with grade 2 and four with grade 3 tumors. Tumors localized to frontal or temporal regions in seven cases. All patients presented initially with BTRE and developed nonepileptic seizures subsequently. Four patients developed NEAD within 1 month of their tumor diagnosis. One patient developed NEAD 79 months following diagnosis. The diagnosis of NEAD was established in 8 patients by direct visualization of attacks (two during concomitant EEG recording). In the remaining patient, diagnosis was based on history (patient and witness). Six patients were diagnosed with concomitant low mood and/ or anxiety and three were commenced on antidepressant medication. At the time of last review, the predominant attacks were nonepileptic in all but one patient.
癫痫发作是脑瘤患者的一种常见症状，但人们对该人群中同时存在的非癫痫性发作障碍（NEAD）知之甚少。NEAD 的诊断具有一定挑战性，尤其是在伴有癫痫的患者中。NEAD 与较高的发病率相关，这通常是由于并存的心理因素所致，可能需要多个科室的共同参与。在肿瘤早期积极治疗使患者生存期延长的时代，患者对疾病的心理适应问题日益凸显。在本病例系列中，我们描述了 9 例在五年期间（2015-2020 年）因脑瘤相关性癫痫（BTRE）就诊于神经科且同时存在 NEAD 的患者。我们介绍了他们的肿瘤特征、治疗经过以及可能导致其表现的因素。我们对就诊于癫痫科的表现为 BTRE 的患者进行了病历回顾，根据临床特征和与 EEG 的相关性，诊断为 NEAD。患者年龄 26-63 岁，2 例患者诊断为 1 级肿瘤，3 例为 2 级，4 例为 3 级。肿瘤位于 7 例患者的额或颞叶区域。所有患者最初表现为 BTRE，随后出现非癫痫性发作。4 例患者在肿瘤诊断后 1 个月内出现 NEAD。1 例患者在诊断后 79 个月出现 NEAD。8 例患者通过直接观察发作（2 例同时进行 EEG 记录）确定 NEAD 的诊断，另 1 例患者根据病史（患者和目击者）诊断。6 例患者被诊断为并发情绪低落和/或焦虑，3 例开始服用抗抑郁药物。在最后一次随访时，除 1 例患者外，其余患者的主要发作均为非癫痫性。
