Argento Elena, Omene Egiroh, Jaeger Alexandria H, Kertes Angela, Mitchell Kaitlyn A, Necyk Candace, Thielking Paul, Lewis Evan Cole
Numinus Wellness Inc., Vancouver, BC, Canada.
Faculty of Medicine, British Columbia Centre on Substance Use, University of British Columbia, Vancouver, BC, Canada.
Front Neurosci. 2023 Jun 12;17:1197409. doi: 10.3389/fnins.2023.1197409. eCollection 2023.
Functional seizures, a primary subtype of functional neurological disorder (FND), are a known cause of serious neurological disability with an increasing awareness of their impact amongst the neuroscience community. Situated at the intersection of neurology and psychiatry, FND is characterized by a range of alterations in motor, sensory or cognitive performance, such as abnormal movements, limb weakness, and dissociative, seizure-like episodes. Functional seizures are known, in part, to have psychological underpinnings; however, the lack of effective and consistent treatment options requires research and novel approaches to better understand the etiology, diagnosis and what constitutes a successful intervention. Ketamine, a selective blocker of the N-methyl-D-aspartate receptor, has a well-established safety and efficacy profile. In recent years, ketamine-assisted therapy has shown increasing potential for treating a broad range of psychiatric conditions, building on its demonstrated rapid-acting antidepressant effects. Here we present a 51-year-old female with refractory daily functional seizures leading to significant disability and a medical history significant for major depressive disorder (MDD) and posttraumatic stress disorder (PTSD). After unsuccessful treatment attempts, the patient underwent a novel protocol with ketamine-assisted therapy. After 3 weeks of ketamine-assisted therapy followed by 20 weeks of intermittent ketamine treatment and ongoing integrative psychotherapy, the patient's seizures were significantly reduced in frequency and severity. She experienced significant improvements in depressive symptoms and functional ability scores. To our knowledge, this is the first reported case describing improvement in functional seizures following ketamine-assisted therapy. While rigorous studies are needed, this case report encourages further investigation of ketamine-assisted therapy for functional seizures and other functional neurological symptoms.
功能性癫痫是功能性神经障碍（FND）的一种主要亚型，是导致严重神经功能残疾的已知原因，神经科学界对其影响的认识也在不断提高。FND 位于神经病学和精神病学的交叉点，其特征是运动、感觉或认知表现出现一系列改变，如异常运动、肢体无力以及解离性癫痫样发作。部分已知功能性癫痫有心理基础；然而，缺乏有效且一致的治疗方案需要开展研究并采用新方法，以更好地理解其病因、诊断以及成功干预的构成要素。氯胺酮是 N-甲基-D-天冬氨酸受体的选择性阻滞剂，具有公认的安全性和疗效。近年来，基于其已证实的快速抗抑郁作用，氯胺酮辅助治疗在治疗多种精神疾病方面显示出越来越大的潜力。在此，我们介绍一名 51 岁女性，她每天发作难治性功能性癫痫，导致严重残疾，且有重度抑郁症（MDD）和创伤后应激障碍（PTSD）病史。在治疗尝试失败后，该患者接受了氯胺酮辅助治疗的新方案。经过 3 周的氯胺酮辅助治疗，随后 20 周的间歇性氯胺酮治疗以及持续的综合心理治疗，患者癫痫发作的频率和严重程度显著降低。她的抑郁症状和功能能力评分有了显著改善。据我们所知，这是首例报道的描述氯胺酮辅助治疗后功能性癫痫有所改善的病例。虽然需要进行严格的研究，但该病例报告鼓励进一步研究氯胺酮辅助治疗功能性癫痫及其他功能性神经症状。
