Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia.
Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.
Epilepsia. 2023 Jan;64(1):184-195. doi: 10.1111/epi.17449. Epub 2022 Nov 7.
Childhood trauma has been implicated as a risk factor for the etiology of psychogenic nonepileptic seizures (PNES). Relatively little attention has been paid to whether profiles of specific trauma types differ between patients with epilepsy and PNES. Investigating childhood trauma profiles in these patient groups may identify psychological vulnerabilities that predispose to developing PNES, and aid early diagnoses, prevention, and treatment.
Data were collected from two cohorts (n = 203; n = 209) admitted to video-electroencephalography (EEG) monitoring units in Melbourne Australia. The differences in Childhood Trauma Questionnaire domain score between patient groups were investigated using standardized effect sizes and general linear mixed-effects models (GLMMs). Receiver-operating characteristic curves were used to investigate classification accuracy.
In the retrospective cohort, patients diagnosed with PNES reported greater childhood emotional abuse, emotional neglect, physical abuse, sexual abuse, and physical neglect relative to patients with epilepsy. These differences were replicated in the prospective cohort, except for physical abuse. GLMMs revealed significant main effects for group in both cohorts, but no evidence for any group by domain interactions. Reported sexual abuse showed the best screening performance of PNES, although no psychometric scores were adequate as isolated measures.
Patients with PNES report a greater frequency of childhood trauma than patients with epilepsy. This effect appears to hold across all trauma types, with no strong evidence emerging for a particular trauma type that is more prevalent in PNES. From a practical perspective, inquiry regarding a history of sexual abuse shows the most promise as a screening measure.
童年创伤被认为是精神性非癫痫性发作（PNES）发病的一个风险因素。相对较少关注癫痫和 PNES 患者之间特定创伤类型的特征是否存在差异。研究这些患者群体的童年创伤特征可能会发现使 PNES 易于发生的心理脆弱性，并有助于早期诊断、预防和治疗。
从澳大利亚墨尔本的视频脑电图（EEG）监测单元中收集了两个队列的数据（n=203；n=209）。使用标准化效应量和广义线性混合效应模型（GLMM）研究了患者组之间童年创伤问卷域评分的差异。使用接收器工作特征曲线来研究分类准确性。
在回顾性队列中，与癫痫患者相比，被诊断为 PNES 的患者报告了更多的童年情绪虐待、情绪忽视、身体虐待、性虐待和身体忽视。前瞻性队列中也复制了这些差异，但没有身体虐待的差异。GLMM 在两个队列中均显示出组的显著主要影响，但没有任何组与域交互的证据。报告的性虐待对 PNES 的筛查性能最好，尽管没有任何心理计量评分可以作为单独的测量方法足够准确。
PNES 患者报告的童年创伤频率高于癫痫患者。这种影响似乎适用于所有创伤类型，没有出现 PNES 中更常见的特定创伤类型的有力证据。从实际的角度来看，询问性虐待史作为筛查措施显示出最大的前景。
