Benbadis S R, Lancman M E, King L M, Swanson S J
Medical College of Wisconsin, Department of Neurology, Milwaukee, USA.
Neurology. 1996 Jul;47(1):63-7. doi: 10.1212/wnl.47.1.63.
The diagnosis of psychogenic seizures (pseudoseizures) may be difficult and usually rests on video-EEG monitoring. We observed that pseudoseizures often arise out of a state that we termed preictal pseudosleep. The objective of this study was to investigate this potential new sign in pseudoseizures.
We prospectively studied all patients who underwent noninvasive monitoring over a 10-month period. Patients were monitored for a duration of 1 to 19 days (mean 4.9), and were divided into two groups: pseudoseizures and epileptic seizures. Patients with both conditions were excluded. Preictal pseudosleep was defined as a state that resembled normal sleep by behavioral criteria alone (i.e. patient motionless and eyes closed), while EEG showed evidence of wakefulness (alpha rhythm, active EMG, and rapid eye movement). This state had to be sustained for at least 1 minute before clinical onset.
Patients had 1 to 25 (mean 7) clinical events recorded. Preictal pseudosleep was seen in 10 of 18 patients with pseudoseizures and in none of 39 patients with epileptic seizures, yielding a sensitivity of 56% and a specificity of 100% for pseudoseizures.
Because of a high specificity, preictal pseudosleep may be a useful adjunctive finding to support the diagnosis of pseudoseizures.
心因性发作（假性发作）的诊断可能存在困难，通常依赖于视频脑电图监测。我们观察到假性发作常源于一种我们称之为发作前期假睡眠的状态。本研究的目的是调查这种假性发作中潜在的新体征。
我们前瞻性地研究了在10个月期间接受无创监测的所有患者。患者监测时长为1至19天（平均4.9天），并分为两组：假性发作组和癫痫发作组。同时患有这两种情况的患者被排除。发作前期假睡眠被定义为仅通过行为标准（即患者静止不动且眼睛闭合）类似于正常睡眠的一种状态，而脑电图显示有清醒的证据（阿尔法节律、活跃的肌电图和快速眼动）。这种状态在临床发作前必须持续至少1分钟。
患者记录到1至25次（平均7次）临床事件。18例假性发作患者中有10例出现发作前期假睡眠，39例癫痫发作患者中无一例出现，假性发作的敏感性为56%，特异性为100%。
由于特异性高，发作前期假睡眠可能是支持假性发作诊断的一项有用的辅助发现。
