Chabolla D R, Krahn L E, So E L, Rummans T A
Department of Neurology, Mayo Clinic Jacksonville, Florida, USA.
Mayo Clin Proc. 1996 May;71(5):493-500. doi: 10.4065/71.5.493.
Psychogenic nonepileptic seizures (NES) are commonly encountered in clinical practice, and they may pose difficult diagnostic problems. For appropriate evaluation and treatment of NES, a multidisciplinary team approach is needed; typically, a neurologist with expertise in epilepsy, a psychologist or psychiatrist, and a support staff should be involved. Psychogenic NES have no single initial clinical manifestation, and various etiologic factors may contribute to their development. Of importance, psychogenic NES are "real" seizures that may be as disabling as epileptic seizures. Most often, they occur on a subconscious level, and the patient may have no control over their occurrence. Precipitation or termination of a habitual seizure during video-electroencephalographic monitoring has often been used to distinguish NES from epileptic seizures, but the results can sometimes be misleading. Numerous additional diagnostic techniques can be used to assist in making the diagnosis. Treatment is based on the type of psychiatric disorder present. Favorable prognostic factors include being female and having an independent lifestyle, normal electroencephalographic findings, higher intelligence, and no prior psychotherapy.
心因性非癫痫性发作（NES）在临床实践中很常见，可能会带来诊断难题。为了对NES进行恰当评估和治疗，需要多学科团队协作；通常，应包括一名癫痫领域的神经科专家、一名心理学家或精神科医生以及一名辅助人员。心因性NES没有单一的初始临床表现，多种病因可能促使其发作。重要的是，心因性NES是“真正的”发作，其致残性可能与癫痫发作一样。它们大多在潜意识层面发生，患者可能无法控制其发作。视频脑电图监测期间习惯性发作的诱发或终止常被用于区分NES和癫痫发作，但结果有时可能会产生误导。还可使用许多其他诊断技术来辅助诊断。治疗基于所存在的精神障碍类型。良好的预后因素包括女性、有独立的生活方式、脑电图结果正常、智力较高以及未曾接受过心理治疗。
