Spierer Ronen, Herskovitz Moshe
Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
Department of Neurology, Rambam Health Care Campus, Haifa, Israel.
Epileptic Disord. 2025 Aug;27(4):642-647. doi: 10.1002/epd2.70051. Epub 2025 Jun 4.
Status non-epilepticus is characterized by recurrent or prolonged psychogenic non-epileptic seizures (PNES), which are often mistaken for status epilepticus (SE). This study focuses on the misdiagnosis of convulsive SE in patients whose seizures were of psychogenic origin.
We analyzed 13 events of 8 patients initially misdiagnosed as having convulsive SE. The diagnostic evaluation included a review of their clinical presentation, treatment, and treatment response.
The patients in this study were predominantly treated with benzodiazepines (BZD). However, this treatment, together with anti-seizure medications (ASM) was mostly ineffective, leading to tracheal intubation in eight of the cases.
When a convulsive event does not cease with BZD and ASM, we suggest considering a differential diagnosis of PNES. The poor response to BZD raises several hypotheses regarding the origin of PNES.
非癫痫持续状态的特征是反复出现或持续时间较长的精神性非癫痫发作（PNES），这些发作常被误诊为癫痫持续状态（SE）。本研究聚焦于发作起源为精神性的患者中惊厥性SE的误诊情况。
我们分析了8例最初被误诊为惊厥性SE的患者的13次发作事件。诊断评估包括对其临床表现、治疗及治疗反应的回顾。
本研究中的患者主要接受苯二氮䓬类药物（BZD）治疗。然而，这种治疗以及抗癫痫药物（ASM）大多无效，导致其中8例患者进行了气管插管。
当惊厥事件在使用BZD和ASM后仍未停止时，我们建议考虑对PNES进行鉴别诊断。对BZD反应不佳引发了关于PNES起源的几种假设。
