Aboukasm A, Mahr G, Gahry B R, Thomas A, Barkley G L
Department of Neurology, Henry Ford Hospital, Detroit, Michigan 48202, USA.
Epilepsia. 1998 May;39(5):470-3. doi: 10.1111/j.1528-1157.1998.tb01407.x.
Uncertainty exists regarding the effectiveness of psychotherapy in patients with psychogenic nonepileptic seizures (PNES). We retrospectively reviewed the outcomes of therapeutic interventions in a cohort of patients with PNES.
We identified patients with PNES by outpatient video-EEG (VEEG) between 1992 and 1996. We retrospectively analyzed the effects on outcomes of various types of interventions for PNES administered at random, using a structured interview and review of medical records. Patients with subjective events and severe psychosis were excluded. Patients who required inpatient monitoring because the outpatient VEEG was inconclusive were also excluded.
One hundred patients were diagnosed with PNES between 1992 and 1996: 61 patients completed the study. The average age was 43.3 years, and 90% were female. Nine (15%) had had PNES <1 year, and 7 (11%) had epilepsy. Eleven of 16 patients (68%) who received five or more counseling sessions, including showing the videotaped recording of the nonepileptic spell (13 of 16) by the comprehensive epilepsy program (CEP) psychotherapist had cessation (7 of 16) or reduction (4 of 16) of their episodes. Eleven of 15 patients (73%) who received only the feedback and care of their CEP neurologists had similar favorable outcome. Twelve of 25 patients (48%) who received counseling by a non-CEP psychotherapist or psychiatrist had cessation (10 of 25) or reduction (2 of 25) of episodes. Five patients who received no feedback or intervention had no improvement (4 of 5) or worsening (1 of 5) of the PNES.
Psychotherapy or feedback provided by CEP professionals with experience in epilepsy and PNES improves outcome and may be superior to other or no interventions.
心理治疗对心因性非癫痫性发作（PNES）患者的有效性尚不确定。我们回顾性分析了一组PNES患者的治疗干预结果。
我们通过门诊视频脑电图（VEEG）在1992年至1996年间识别出PNES患者。我们回顾性分析了随机给予的各种类型PNES干预措施对结局的影响，采用结构化访谈和病历审查。排除有主观事件和严重精神病的患者。因门诊VEEG结果不明确而需要住院监测的患者也被排除。
1992年至1996年间，100例患者被诊断为PNES，61例患者完成了研究。平均年龄为43.3岁，90%为女性。9例（15%）PNES发作时间<1年，7例（11%）有癫痫病史。16例接受五次或更多次咨询的患者中，11例（68%），包括由综合癫痫项目（CEP）心理治疗师展示非癫痫发作的录像（16例中的13例），发作停止（16例中的7例）或减少（16例中的4例）。15例仅接受CEP神经科医生反馈和护理的患者中，11例（73%）有类似的良好结局。25例接受非CEP心理治疗师或精神科医生咨询的患者中，12例（48%）发作停止（25例中的10例）或减少（25例中的2例）。5例未接受反馈或干预的患者，PNES无改善（5例中的4例）或恶化（5例中的1例）。
由有癫痫和PNES治疗经验的CEP专业人员提供的心理治疗或反馈可改善结局，可能优于其他干预措施或不干预。
