Cohen R J, Suter C
Ann Neurol. 1982 Apr;11(4):391-5. doi: 10.1002/ana.410110413.
We studied 57 patients with poorly controlled or atypical seizures to identify hysterical attacks with a provocative test consisting of initiation and termination of an attack with suggestion and saline injection during electroencephalographic (EEG) monitoring. Using this method, we diagnosed 48 patients as having hysterical attacks. Three additional patients had spontaneous hysterical attacks during routine recordings. Of the 51 patients with hysterical attacks, 78% were female. Two-thirds of the patients were between the ages of 20 and 35 years. Thirty-two patients had taken anticonvulsants before the study. Each patient's hysterical attack, aura, and postictum was stereotyped, and the 6 patients subject to both hysterical and organic seizures described the two types of attacks as different stereotyped behaviors. Tongue laceration, urinary incontinence, and postictal confusion were common. Twelve patients had evidence of past or present neurological disease. Abnormal EEGs were recorded in 37% but only 12% had spike or spike and wave discharges. The provocative EEG test employing saline and suggestion is a useful tool in the diagnosis of hysterical "seizures."
我们研究了57例癫痫控制不佳或发作不典型的患者，通过在脑电图（EEG）监测期间进行一项激发试验来识别癔症发作，该试验包括通过暗示和注射生理盐水引发和终止发作。使用这种方法，我们诊断出48例患者患有癔症发作。另外3例患者在常规记录期间出现自发性癔症发作。在51例患有癔症发作的患者中，78%为女性。三分之二的患者年龄在20至35岁之间。32例患者在研究前服用过抗惊厥药。每位患者的癔症发作、先兆和发作后状态都是刻板的，6例同时患有癔症和器质性癫痫的患者将两种发作描述为不同的刻板行为。舌咬伤、尿失禁和发作后意识模糊很常见。12例患者有既往或目前神经系统疾病的证据。37%的患者脑电图异常，但只有12%有棘波或棘慢波放电。采用生理盐水和暗示的激发性脑电图试验是诊断癔症“发作”的有用工具。
