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  • 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Budapest, Baross u. 27., 1088
  • 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Budapest
Open access

Absztrakt

A pszichogén, nem epilepsziás roham a pszichiátria és neurológia határterületén lévő, nehezen behatárolható tünetegyüttes, amely tünetmintázatában hasonlít az epilepsziára, de azt nem epilepsziás aktivitás váltja ki. Jellemzően fiatal felnőttkorban alakul ki, a betegek körében a nők aránya jóval magasabb. A pszichogén, nem epilepsziás roham diagnosztikája elsősorban video-elektroencefalográfiás vizsgálattal történhet, amely az esetek 90%-ában a helyes diagnózis megállapításához vezethet. A kórképet mégis gyakran diagnosztizálják tévesen epilepsziának, és kezelik évekig ennek megfelelően, ami a betegekre és az egészségügyi ellátórendszerre egyaránt nagy terhet ró. A kórkép etiológiájában – az anamnézisben szereplő traumatikus életesemények gyakorisága miatt – kiemelt szerepet tulajdonítanak a pszichológiai faktoroknak. Emellett a pszichogén nem epilepsziás roham kialakulásában neurobiológiai tényezők is közrejátszanak, amelyre a betegek egy részénél talált kognitív, strukturális és funkcionális agyi eltérések utalnak. A kezelés pszichoszociális – elsősorban kognitív viselkedésterápiás – intervenciókat és kiegészítő farmakoterápiát foglal magába. A tanulmányban a szerzők a pszichogén nem epilepsziás roham tünettanával, diagnosztikájával, etiológiájával és kezelésével kapcsolatos irodalmat és az újabb kutatási eredményeket tekintik át. Orv. Hetil., 2016, 157(20), 767–775.

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  • 1

    LaFrance, W. C. Jr., Devinsky, O.: The treatment of nonepileptic seizures: historical perspectives and future directions. Epilepsia, 2004, 45(Suppl. 2), 15–21.

  • 2

    Bodde, N. M., Brooks, J. L., Baker, G. A., et al.: Psychogenic non-epileptic seizures – definition, etiology, treatment and prognostic issues: a critical review. Seizure, 2009, 18(8), 543–553.

  • 3

    Dickinson, P., Looper, K. J.: Psychogenic nonepileptic seizures: a current overview. Epilepsia, 2012, 53(10), 1679–1689.

  • 4

    Ellenberger, H. F.: The discovery of the unconscious; the history and evolution of dynamic psychiatry. Basic Books, New York, 1970.

  • 5

    Van der Kolk, B. A., Fisler, R.: Dissociation and the fragmentary nature of traumatic memories: overview and exploratory study. J. Trauma Stress, 1995, 8(4), 505–525.

  • 6

    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: DSM-5. American Psychiatric Association Publishing, Washington, 2013.

  • 7

    World Health Organization: The ICD-10 Classification of Mental and Behavioural Disorders. Clinical descriptions and diagnostic guidelines. 10th revision. WHO, Geneva, 1992.

  • 8

    Schmutz, M.: Dissociative seizures – a critical review and perspective. Epilepsy Behav., 2013, 29(3), 449–456.

  • 9

    Asadi-Pooya, A. A., Sperling, M. R.: Epidemiology of psychogenic nonepileptic seizures. Epilepsy Behav., 2015, 46, 60–65.

  • 10

    Sigurdardottir, K. R., Olafsson, E.: Incidence of psychogenic seizures in adults: a population-based study in Iceland. Epilepsia, 1998, 39(7), 749–752.

  • 11

    Duncan, R., Razvi, S., Mulhern, S.: Newly presenting psychogenic nonepileptic seizures: incidence, population characteristics, and early outcome from a prospective audit of a first seizure clinic. Epilepsy Behav., 2011, 20(2), 308–311.

  • 12

    Benbadis, S. R., Allen-Hauser, W.: An estimate of the prevalence of psychogenic non-epileptic seizures. Seizure, 2000, 9(4), 280–281.

  • 13

    Martin, R., Burneo, J. G., Prasad, A., et al.: Frequency of epilepsy in patients with psychogenic seizures monitored by video-EEG. Neurology, 2003, 61(12), 1791–1792.

  • 14

    Marchetti, R. L., Kurcgant, D., Gallucci-Neto, J., et al.: Epilepsy in patients with psychogenic non-epileptic seizures. Arq. Neuropsiquiatr., 2010, 68(2), 168–173.

  • 15

    Szabó, L., Siegler, Z., Zubek, L., et al.: A detailed semiologic analysis of childhood psychogenic nonepileptic seizures. Epilepsia, 2012, 53(3), 565–570.

  • 16

    Asadi-Pooya, A. A., Emami, M.: Juvenile and adult-onset psychogenic non-epileptic seizures. Clin. Neurol. Neurosurg., 2013, 115(9), 1697–1700.

  • 17

    Rosenbaum, M.: Psychogenic seizures – why women? Psychosomatics, 2000, 41(2), 147–149.

  • 18

    Oto, M., Conway, P., McGonigal, A., et al.: Gender differences in psychogenic non-epileptic seizures. Seizure, 2005, 14(1), 33–39.

  • 19

    Seneviratne, U., Briggs, B., Lowenstern, D., et al.: The spectrum of psychogenic non-epileptic seizures and comorbidities seen in an epilepsy monitoring unit. J. Clin. Neurosci., 2011, 18(3), 361–363.

  • 20

    Reuber, M.: Are psychogenic non-epileptic seizures an expression of neurologic pathology? In: Kanner, A. M., Schachter, S. C. (eds.): Psychiatric controversies in epilepsy. Academic Press, San Diego, 2008.

  • 21

    Varela, H., Benbadis, S. R.: Episodic neurologic symptoms. In: Schoenberg, M. R., Scott, J. G. (eds.): The little black book of neuropsychology. A syndrome-based approach. Springer Science & Business Media, New York, 2011.

  • 22

    LaFrance, W. C. Jr.: Psychogenic nonepileptic seizures. Curr. Opin. Neurol., 2008, 21(2), 195–201.

  • 23

    Benbadis, S. R.: Provocative techniques should be used for the diagnosis of psychogenic nonepileptic seizures. Epilepsy Behav., 2009, 15(2), 106–109.

  • 24

    Avbersek, A., Sisodiya, S.: Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures? J. Neurol. Neurosurg. Psychiatry, 2010, 81(7), 719–725.

  • 25

    Gates, J. R., Ramani, V., Whalen, S., et al.: Ictal characteristics of pseudoseizures. Arch. Neurol., 1985, 42(12), 1183–1187.

  • 26

    Dikmen, P. Y., Unlusoy Acar, Z., Gurses, C.: Clinical events in psychogenic non-epileptic seizures based on semiological seizure classification. Neurol. Res., 2013, 35(10), 1070–1075.

  • 27

    Gröppel, G., Kapitany, T., Baumgartner, C.: Cluster analysis of clinical seizure semiology of psychogenic nonepileptic seizures. Epilepsia, 2000, 41(5), 610–614.

  • 28

    Seneviratne, U., Reutens, D., D’Souza, W.: Stereotypy of psychogenic nonepileptic seizures: insights from video-EEG monitoring. Epilepsia, 2010, 51(7), 1159–1168.

  • 29

    Hubsch, C., Baumann, C., Hingray, C., et al.: Clinical classification of psychogenic non-epileptic seizures based on video-EEG analysis and automatic clustering. J. Neurol. Neurosurg. Psychiatry, 2011, 82(9), 955–960.

  • 30

    Dhiman, V., Sinha, S., Rawat, V. S., et al.: Semiological characteristics of adults with psychogenic nonepileptic seizures (PNESs): an attempt towards a new classification. Epilepsy Behav., 2013, 27(3), 427–432.

  • 31

    Wadwekar, V., Nair, P. P., Murgai, A., et al.: Semiologic classification of psychogenic non epileptic seizures (PNES) based on video EEG analysis: do we need new classification systems? Seizure, 2014, 23(3), 222–226.

  • 32

    Gedzelman, E. R., LaRoche, S. M.: Long-term video EEG monitoring for diagnosis of psychogenic nonepileptic seizures. Neuropsychiatr. Dis. Treat., 2014, 10, 1979–1986.

  • 33

    Beniczky, S., Conradsen, I., Moldovan, M., et al.: Automated differentiation between epileptic and nonepileptic convulsive seizures. Ann. Neurol., 2015, 77(2), 348–351.

  • 34

    Brigo, F., Igwe, S. C., Erro, R., et al.: Postictal serum creatine kinase for the differential diagnosis of epileptic seizures and psychogenic non-epileptic seizures: a systematic review. J. Neurol., 2015, 262(2), 251–257.

  • 35

    LaFrance, W. C. Jr., Deluca, M., Machan, J. T., et al.: Traumatic brain injury and psychogenic nonepileptic seizures yield worse outcomes. Epilepsia, 2013, 54(4), 718–725.

  • 36

    Cuthill, F. M., Espie, C. A.: Sensitivity and specificity of procedures for the differential diagnosis of epileptic and non-epileptic seizures: a systematic review. Seizure, 2005, 14(5), 293–303.

  • 37

    Neiman, E. S., Noe, K. H., Drazkowski, J. F., et al.: Utility of subtraction ictal SPECT when video-EEG fails to distinguish atypical psychogenic and epileptic seizures. Epilepsy Behav., 2009, 15(2), 208–212.

  • 38

    Bodde, N. M., van der Kruijs, S. J., Ijff, D. M., et al.: Subgroup classification in patients with psychogenic non-epileptic seizures. Epilepsy Behav., 2013, 26(3), 279–289.

  • 39

    Dixit, R., Popescu, A., Bagić, A., et al.: Medical comorbidities in patients with psychogenic nonepileptic spells (PNES) referred for video-EEG monitoring. Epilepsy Behav., 2013, 28(2), 137–140.

  • 40

    Salmon, P., Al-Marzooqi, S. M., Baker, G.: Childhood family dysfunction and associated abuse in patients with nonepileptic seizures: towards a causal model. Psychosom. Med., 2003, 65(4), 695–700.

  • 41

    Owczarek, K.: Somatisation indexes as differential factors in psychogenic pseudoepileptic and epileptic seizures. Seizure, 2003, 12(3), 178–181.

  • 42

    Alsaadi, T. M., Marquez, A. V.: Psychogenic nonepileptic seizures. Am. Fam. Physician, 2005, 72(5), 849–856.

  • 43

    Bernstein, E. M., Putnam, F. W.: Development, reliability, and validity of a dissociation scale. J. Nerv. Ment. Dis., 1986, 174(12), 727–735.

  • 44

    Bowman, E. S., Markand, O. N.: Psychodynamics and psychiatric diagnoses of pseudoseizure subjects. Am. J. Psychiatry, 1996, 153(1), 57–63.

  • 45

    Baslet, G., Roiko, A., Prensky, E.: Heterogeneity in psychogenic nonepileptic seizures: understanding the role of psychiatric and neurological factors. Epilepsy Behav., 2010, 17(2), 236–241.

  • 46

    Duncan, R, Oto, M.: Psychogenic nonepileptic seizures in patients with learning disability: comparison with patients with no learning disability. Epilepsy Behav., 2008, 12(1), 183–186.

  • 47

    Drane, D. L., Williamson, D. J., Stroup, E. S., et al.: Cognitive impairment is not equal in patients with epileptic and psychogenic nonepileptic seizures. Epilepsia, 2006, 47(11), 1879–1886.

  • 48

    Van der Kolk, B., van der Hart, O., Marmar, C.: Dissociation and information processing in posttraumatic stress disorder. In: van der Kolk, B. A., McFarlane, A. C., Weisaeth, L. (eds.): Traumatic stress: the effects of overwhelming experience on mind, body and society. Guildford Press, New York, 1996.

  • 49

    Myers, L., Zeng, R., Perrine, K., et al.: Cognitive differences between patients who have psychogenic nonepileptic seizures (PNESs) and posttraumatic stress disorder (PTSD) and patients who have PNESs without PTSD. Epilepsy Behav., 2014, 37, 82–86.

  • 50

    Labate, A., Cerasa, A., Mula, M., et al.: Neuroanatomic correlates of psychogenic nonepileptic seizures: a cortical thickness and VBM study. Epilepsia, 2012, 53(2), 377–385.

  • 51

    DeLange, F. P., Toni, I., Roelofs, K., et al.: Altered connectivity between prefrontal and sensorimotor cortex in conversion paralysis. Neuropsychologia, 2010, 48(6), 1782–1788.

  • 52

    Ding, J. R., An, D., Liao, W., et al.: Altered functional and structural connectivity networks in psychogenic non-epileptic seizures. PLoS ONE, 2013, 8(5), e63850.

  • 53

    Arthuis, M., Micoulaud-Franchi, J. A., Bartolomei, F., et al.: Resting cortical PET metabolic changes in psychogenic non-epileptic seizures (PNES). J. Neurol. Neurosurg. Psychiatry, 2015, 86(10), 1106–1112.

  • 54

    Perez, D. L., Dworetzky, B. A., Dickerson, B. C., et al.: An integrative neurocircuit perspective on psychogenic nonepileptic seizures and functional movement disorders: neural functional unawareness. Clin. EEG Neurosci., 2015, 46(1), 4–15.

  • 55

    Prigatano, G. P., Stonnington, C. M., Fisher, R. S., et al.: Psychological factors in the genesis and management of nonepileptic seizures: clinical observations. Epilepsy Behav., 2002, 3(4), 343–349.

  • 56

    Reuber, M., Elger, C. E.: Psychogenic nonepileptic seizures: review and update. Epilepsy Behav., 2003, 4(3), 205–216.

  • 57

    Farias, S. T., Thieman, C., Alsaadi, T. M.: Psychogenic nonepileptic seizures: acute change in event frequency after presentation of the diagnosis. Epilepsy Behav., 2003, 4(4), 424–429.

  • 58

    LaFrance, W. C. Jr., Baird, G. L., Barry, J. J., et al.: Multicenter pilot treatment trial for psychogenic nonepileptic seizures: a randomized clinical trial. JAMA Psychiatry, 2014, 71(9), 997–1005.

  • 59

    Goldstein, L. H., Chalder, T., Chigwedere, C., et al.: Cognitive-behavioral therapy for psychogenic nonepileptic seizures: a pilot RCT. Neurology, 2010, 74(24), 1986–1994.

  • 60

    Kalogjera-Sackellares, D.: Psychodynamics and psychotherapy of pseudoseizures. Crown House Publishing, Carmarthen, 2004.

  • 61

    Barry, J. J., Wittenberg, D., Bullock, K. D., et al.: Group therapy for patients with psychogenic nonepileptic seizures: a pilot study. Epilepsy Behav., 2008, 13(4), 624–629.

  • 62

    Baslet, G., Dworetzky, B., Perez, D. L., et al.: Treatment of psychogenic nonepileptic seizures: updated review and findings from a mindfulness-based intervention case series. Clin. EEG Neurosci., 2015, 46(1), 54–64.

  • 63

    LaFrance, W. C. Jr., Blumer, D.: Pharmacological treatments for psychogenic nonepileptic seizures. In: Schachter, S. C., LaFrance, W. C. Jr. (eds.): Gates and Rowan’s nonepileptic seizures. Cambridge University Press, New York, 2010.

  • 64

    Kuyk, J., Siffels, M. C., Bakvis, P., et al.: Psychological treatment of patients with psychogenic non-epileptic seizures: an outcome study. Seizure, 2008, 17(7), 595–603.

  • 65

    Wyllie, E., Friedman, D., Lüders, H., et al.: Outcome of psychogenic seizures in children and adolescents compared with adults. Neurology, 1991, 41(5), 742–744.

  • 66

    Reilly, C., Menlove, L., Fenton, V., et al.: Psychogenic nonepileptic seizures in children: a review. Epilepsia, 2013, 54(10), 1715–1724.

  • 67

    Gudmundsson, O., Prendergast, M., Foreman, D., et al.: Outcome of pseudoseizures in children and adolescents: a 6-year symptom survival analysis. Dev. Med. Child Neurol., 2001, 43(8), 547–551.

 

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