National Centre for Epilepsy, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Department of Neurohabilitation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway; Department of Rare Genetic Disorders, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.
Epilepsy Behav. 2022 Oct;135:108890. doi: 10.1016/j.yebeh.2022.108890. Epub 2022 Aug 28.
Insecure and fearful attachment styles have been reported in psychogenic nonepileptic seizures (PNES). We have investigated associations between long-term clinical outcome in PNES, parenting and attachment styles and demographic, clinical, and neuropsychiatric factors.
Patients aged at least 16 years and with documented PNES, according to criteria from the International League Against Epilepsy, were prospectively recruited to this study. They were assessed at baseline to determine clinical characteristics, experience of attachment and perceptions of experienced parenting styles, trauma history, dissociation, and health-related quality of life. At a mean of 70.45 (SD 29.0, range 22-130) months after inclusion, participants were contacted by telephone and asked about their current medical status and psychiatric/psychological interventions.
Of 53 patients included in the study, 51 (96 %) provided follow-up data. Most (84.9 %) patients were female, and the mean age of PNES onset was 25.6 years. At follow-up, 20 patients (39 %) were free of PNES. Those patients that had achieved PNES freedom at follow-up had lower levels of attachment anxiety (p = 0.01) and reported to have experienced their fathers as less controlling (p = 0.02) and their mothers as more caring (p = 0.04) at baseline compared with those patients still suffering from PNES. Seizure freedom at follow-up was predicted by male gender, younger age at PNES onset, and less attachment anxiety.
In our cohort from a tertiary epilepsy center the long-term prognosis of PNES is poor. Attachment anxiety is a risk factor for persistent PNES. It may be of therapeutic relevance to assess attachment patterns in patients with PNES.
研究报告称，心因性非癫痫性发作（PNES）患者存在不安全和恐惧的依恋风格。我们研究了 PNES 的长期临床结果、养育方式和依恋风格与人口统计学、临床和神经精神因素之间的关联。
本研究前瞻性招募了至少 16 岁且根据国际抗癫痫联盟标准确诊为 PNES 的患者。他们在基线时接受评估，以确定临床特征、依恋经历和对经历过的养育方式的看法、创伤史、分离和健康相关生活质量。在纳入后平均 70.45 个月（SD 29.0，范围 22-130）时，通过电话联系参与者，询问他们当前的医疗状况和精神/心理干预情况。
在纳入的 53 名患者中，有 51 名（96%）提供了随访数据。大多数（84.9%）患者为女性，PNES 发病的平均年龄为 25.6 岁。在随访时，20 名患者（39%）无 PNES。与仍患有 PNES 的患者相比，随访时达到 PNES 自由的患者的依恋焦虑程度较低（p=0.01），并且报告他们的父亲控制欲较低（p=0.02），母亲更关心（p=0.04）。随访时无癫痫发作与男性、PNES 发病年龄较小和较低的依恋焦虑相关。
在我们的三级癫痫中心队列中，PNES 的长期预后较差。依恋焦虑是持续 PNES 的危险因素。在 PNES 患者中评估依恋模式可能具有治疗意义。
