Kimura Kenichi, Nakamura Yuichi, Yokoyama Kenki, Fujii Yutaka, Horinouchi Toru
Department of Psychiatry and Neurology, Hokkaido University Hospital, Sapporo, JPN.
Department of Psychiatry, Hokkaido Prefectural Koyogaoka Hospital, Abashiri, JPN.
Cureus. 2024 Sep 2;16(9):e68445. doi: 10.7759/cureus.68445. eCollection 2024 Sep.
Psychogenic non-epileptic seizures (PNES), which closely resemble epileptic seizures (ES), are typically triggered by psychological distress and represent the most prevalent form of conversion disorder encountered in clinical practice. Multiple physical conditions can both precipitate and sustain PNES episodes. Epilepsy, a common neurological disorder, imposes significant emotional and physical burdens, frequently resulting in elevated levels of anxiety and depression. This case report details the clinical course of a 19-year-old female whose PNES was exacerbated by the diagnosis and disease burden of epilepsy. The patient's background of childhood trauma, bullying, and sexual abuse likely predisposed her to the development of PNES. Upon receiving a diagnosis of epilepsy, characterized by focal seizures originating from the left parietal region, the patient experienced increased anxiety and required frequent hospitalizations. Despite adjustments to her treatment regimen, including the administration of levetiracetam (LEV) and lacosamide (LCM), her seizures persisted. Comprehensive evaluations, comprising electroencephalography (EEG) and single-photon emission computed tomography (SPECT), indicated the coexistence of epilepsy and PNES. Although surgical intervention was initially considered, it was ultimately deemed unnecessary, which subsequently alleviated the patient's anxiety. Psychoeducation highlighting the manageability of her epilepsy with ongoing pharmacotherapy significantly reduced her PNES episodes. This case emphasizes the critical role of addressing the psychosocial burden associated with an epilepsy diagnosis, as these factors may exacerbate PNES. It also underscores the importance of a holistic treatment approach that integrates psychological support with medical management.
心因性非癫痫性发作（PNES）与癫痫性发作（ES）极为相似，通常由心理困扰引发，是临床实践中最常见的转换障碍形式。多种身体状况既可能促使PNES发作，也可能使其持续。癫痫是一种常见的神经系统疾病，会带来巨大的情感和身体负担，常常导致焦虑和抑郁水平升高。本病例报告详细介绍了一名19岁女性的临床病程，其PNES因癫痫的诊断和疾病负担而加重。患者童年创伤、受欺凌和性虐待的背景可能使其易患PNES。在被诊断为癫痫后，其症状为起源于左顶叶区域的局灶性发作，患者焦虑加剧，需要频繁住院。尽管调整了治疗方案，包括给予左乙拉西坦（LEV）和拉科酰胺（LCM），但其发作仍持续。包括脑电图（EEG）和单光子发射计算机断层扫描（SPECT）在内的全面评估表明癫痫和PNES并存。虽然最初考虑了手术干预，但最终认为没有必要，这随后减轻了患者的焦虑。强调通过持续药物治疗可控制癫痫的心理教育显著减少了她的PNES发作次数。本病例强调了应对与癫痫诊断相关的心理社会负担的关键作用，因为这些因素可能会加重PNES。它还强调了将心理支持与医疗管理相结合的整体治疗方法的重要性。
