Cooper Jade, Chester Helen, Fozzato Arianna, Sokolov Elisaveta
Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK.
School of Optometry, Aston University, Birmingham B4 7UP, UK.
Brain Sci. 2024 Nov 26;14(12):1187. doi: 10.3390/brainsci14121187.
This study aimed to investigate the onset time to habitual psychogenic non-epileptic seizures (PNES) in adults referred to Guy's and St Thomas' Neurophysiology Department for home video telemetry (HVT) with a clinical question of PNES. The primary objective was to determine the optimal time window for HVT recording for patients with suspected PNES to try to improve the allocation of clinical resources. The secondary objective was to explore any potential association between time to habitual PN ES onset and demographic indexes and other clinical, neuro-radiological and semiological findings.
We performed a retrospective analysis of our XLTEK database between 2019 and 2020. A multifactorial analysis of PNES semiologic subtypes, patient demographics, psychiatric comorbidities and neuroimaging was conducted to explore their impact on time to PNES within an HVT study. People who had at least one typical PNES during their recording were included. The exclusion criteria included people who had the test performed without video recording. The total number of participants was 37. The data were extracted from our local XLTEK database. Statistical analyses using Mann-Whitney U and Fischer exact tests were carried out.
The mean time to first habitual PNES onset was seven hours, with a mean recording duration of 46 h. The most commonly occurring event type was blank spells (12, 32%), with the least common presentation being déjà vu (1, 3%). There was a significant association between time to PNES onset and male sex ( = 0.04). There was a significant association between time to PNES onset and abnormal MRI findings ( = 0.02). Particular PNES semiologic subtypes were not significantly linked with PNES onset time.
Our study highlights that on average, patients with PNES will rapidly have their first habitual event within an HVT study (mean time to event onset of seven hours), consistent with the current literature. This raises the question of whether HVT study duration could be reduced to release study resources and aid departmental efficiencies. We also observe the novel finding that men presented significantly earlier with their habitual PNES event than women, and that abnormal imaging findings were also significantly associated with an earlier time to event onset, although the reason for this association is yet to be determined.
本研究旨在调查转诊至盖伊和圣托马斯神经生理学部门进行家庭视频遥测（HVT）且临床问题为精神源性非癫痫性发作（PNES）的成人患者出现习惯性PNES的发作时间。主要目的是确定疑似PNES患者进行HVT记录的最佳时间窗口，以试图改善临床资源的分配。次要目的是探讨习惯性PNES发作时间与人口统计学指标以及其他临床、神经放射学和症状学发现之间的任何潜在关联。
我们对2019年至2020年期间的XLTEK数据库进行了回顾性分析。对PNES症状学亚型、患者人口统计学、精神疾病共病情况和神经影像学进行多因素分析，以探讨它们在HVT研究中对PNES发作时间的影响。纳入在记录期间至少有一次典型PNES发作的患者。排除标准包括未进行视频记录就进行检查的患者。参与者总数为37人。数据从我们当地的XLTEK数据库中提取。使用曼-惠特尼U检验和费舍尔精确检验进行统计分析。
首次习惯性PNES发作的平均时间为7小时，平均记录时长为46小时。最常出现的事件类型是空白发作（12例，32%），最不常见的表现是似曾相识感（1例，3%）。PNES发作时间与男性性别之间存在显著关联（P = 0.04）。PNES发作时间与MRI异常结果之间存在显著关联（P = 0.02）。特定的PNES症状学亚型与PNES发作时间无显著关联。
我们的研究强调，平均而言，PNES患者在HVT研究中会很快出现首次习惯性发作（事件发作的平均时间为7小时），这与当前文献一致。这就提出了一个问题，即HVT研究时长是否可以缩短以释放研究资源并提高科室效率。我们还观察到一个新发现，即男性出现习惯性PNES事件的时间明显早于女性，并且影像学异常结果也与事件发作时间较早显著相关，尽管这种关联的原因尚待确定。
