Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Epilepsy Res. 2024 Mar;201:107319. doi: 10.1016/j.eplepsyres.2024.107319. Epub 2024 Feb 13.
To examine trends of Antiseizure Medication (ASM) reduction and discontinuation, as well as Psychogenic Non-Epileptic Seizure (PNES) spell reduction and resolution in patients with PNES, with and without comorbid epileptic seizures (ES).
A retrospective analysis was conducted on data from 145 patients with PNES, including 109 with PNES alone and 36 with PNES plus comorbid epilepsy. Patients were admitted to the Epilepsy Monitoring Unit (EMU) between May 2000 and April 2008, with follow-up clinical data collected until September 2015. Clinical records were thoroughly examined, encompassing the period preceding the PNES diagnosis until either loss to follow-up or September 2015. A subsequent chart review was conducted by two neurologists, covering the period following the diagnosis of PNES until either loss to follow-up or September 2015, which ever came first.
Patients with PNES alone had higher rates of ASM reduction for all variables of ASM reduction measured compared to those with comorbid epilepsy (all at p < 001). Among patients with PNES alone, reductions in ASMs were observed after EMU discharge, but an uptick and plateau were seen in later follow-up years (100% of patients free of ASMs at years 2-3, 20% on at least one ASM by year 7). This pattern differs greatly in PNES + ES patients, in which the only time point at which any patient was able to discontinue all ASMs was at EMU discharge (4.5% of patients), with all patients taking at least one ASM for every other follow-up time point. Reductions in PNES spell frequency did not differ significantly between the two groups (for example PNES spells reduced at final FU 47.2% vs 42.9%, p = 0.65). In both groups, despite an initial drop in variables of PNES spell reduction and resolution in the early years post discharge, there is an eventual rebound and plateau (for example in PNES only patients, 33.9% of patients having no resolution in 1st year FU, which rises to 78% at years 4-5, and plateus around 52.8% at more than 7 years follow-up.) SIGNIFICANCE: This study contributes to the growing body of research focused on improving the current approach to management and prognostic outlook of PNES. Although PNES only patients had higher rates of ASM reduction, the uptick and plateau observed in later years highlights the challenges in managing PNES. Similarly, the continued persistence and rebound of PNES spells underline the continued poor prognostic outcomes associated with this condition.
研究伴有和不伴有癫痫发作（ES）共病的癫痫性全面性发作障碍（PNES）患者中抗癫痫药物（ASM）减量和停药以及假性癫痫发作（PNES）发作减少和缓解的趋势。
对 2000 年 5 月至 2008 年 4 月期间在癫痫监测单元（EMU）住院的 145 例 PNES 患者（109 例单纯 PNES 和 36 例伴有 ES 共病）的数据进行回顾性分析，随访临床数据收集至 2015 年 9 月。仔细检查临床记录，包括 PNES 诊断前的时期，直至失访或 2015 年 9 月，以先到者为准。随后由两位神经科医生对图表进行了回顾，涵盖 PNES 诊断后至失访或 2015 年 9 月的时期，以先到者为准。
单纯 PNES 患者与伴有 ES 的患者相比，所有测量的 ASM 减少变量的 ASM 减少率均更高（均为 p < 001）。单纯 PNES 患者在 EMU 出院后观察到 ASM 减少，但在随后的随访年中出现了上升和稳定（第 2-3 年所有患者均无 ASM，第 7 年至少有 1 种 ASM 的患者为 20%）。这种模式在 PNES + ES 患者中差异很大，在这些患者中，唯一能够停用所有 ASM 的时间点是在 EMU 出院时（4.5%的患者），所有患者在其他随访时间点至少服用 1 种 ASM。两组之间假性癫痫发作频率的减少没有显著差异（例如，最终随访时 PNES 发作减少 47.2%比 42.9%，p = 0.65）。在两组中，尽管在出院后早期 PNES 发作减少和缓解的变量最初有所下降，但最终会出现反弹和稳定（例如，在单纯 PNES 患者中，第 1 年 FU 时无缓解的患者比例为 33.9%，在第 4-5 年上升至 78%，在超过 7 年的随访中稳定在 52.8%左右）。
本研究有助于丰富目前针对 PNES 管理和预后的研究。尽管单纯 PNES 患者的 ASM 减少率较高，但在随后的年份中出现的上升和稳定表明管理 PNES 存在挑战。同样，PNES 发作的持续存在和反弹强调了与这种情况相关的持续不良预后。
