Naslov
Psychogenic nonepileptic seizures

Autori
Korczyn, Amos D. ; Petelin Gadže, Željka

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
Neurologia Croatica. 2018 ; 67(Suppl. 1) / Bilić, Ervina ; Petravić, Damir ; Poljaković, Zdravka - Zagreb : Denona, 2018, 22-23

Skup
6. hrvatski kongres "Dileme u neurologiji"

Mjesto i datum
Poreč, Hrvatska, 02.10.2018. - 06.10.2018

Vrsta sudjelovanja
Pozvano predavanje

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
psychogenic nonepileptic seizures ; frontal lobe epilepsy

Sažetak
Psychogenic nonepileptic seizures (PNES) are commonly diagnosed and treated at epilepsy centers. However, their neurobiology is still poorly understood. Their discrimination from syncope, epileptic seizures (ES), sleep disorders, vascular events or other paroxysmal neurologic symptoms can be difficult and requires profound knowledge of the semiology and clinical presentation of PNES and their differential diagnoses. Moreover, ES and psychogenic seizures often coexist in 10%-20% of patients. Diagnosis relies on multidisciplinary evaluation and is usually based on different combinations of data. No single biomarker can successfully differentiate PNES from ES ; in fact, PNES is only diagnosed via negation of ES. Clinical assessment and rigorous investigation of psychosocial variables specific to PNES remain critical, and subtyping of PNES is warranted. The gold diagnostic standard is the recording of a typical event with video-EEG to confirm the absence of electrographic changes on ictal tracing. Clinically, diagnosis traditionally relies on identification of bizarre or atypical paroxysmal behavioral changes, especially in patients with known psychological or psychiatric disorder. The ictal activity itself may present with discontinuous, uncoordinated activity with erratic progression. Pelvic thrusting, thrashing or flailing movements, jerking movement tremors and the lack of gradual slowing in the rate of clonic activity are more common in PNES, as well as preserved awareness, eye flutter and modification by others, but none of them, individually taken, has high sensitivity. However, no single clinical feature of PNES has proved to be pathognomonic, although recent studies have found that diagnosis is associated with a distinct cluster of signs. On the other hand, video-EEG monitoring not infrequently fails to capture the events and it will not diff erentiate certain types of frontal lobe epileptic seizures from PNES. Accurate diagnoses are important for appropriate treatment, which includes multiple phases. Fewer than 40% of adults with PNES are expected to become seizure-free within 5 years aft er diagnosis. The authors will present their own experience in treating patients with PNES. Pros and cons in the holistic approach to this clinical entity will be discussed.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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