ABSTRACT
Objective To find out whether conversation analysis helps to differentiate psychogenic nonepileptic seizure (PNES) from epileptic seizure in Chinese patients.Methods Twelve unselected patients from Peking Union Medical College Hospital during 2014 to 2016 with diagnostic uncertainty were included.Interactions following standard protocol were carried out.A linguist blinded to all medical data and a neurologist studied videos and transcripts of the interactions.Using a diagnostic scoring aid which includes 17 conversation features summarized from previous researches, they attempted to predict the medical diagnosis of those patients independently.Results Accurate diagnosis was predicted in 10/12 patients by both raters.Average scores of patients with epileptic seizures were 8.00 (linguist) and 6.75 (neurologist), while average scores of paitents with PNES were-5.75 (linguist) and-7.88 (neurologist).Both raters agreed on most individual items (81.86%, 167/204).To demonstrate different features between these two groups, a case comparison was made between one patient with frontal lobe epilepsy and one patient with PNES.Conclusion In Chinese patients, conversation analysis can help differentiate between epileptic seizure and PNES.
ABSTRACT
Discutir as crises ou os eventos paroxísticos que simulem crises epilépticas, enfatizando as diferenças semiológicas entre elas e as perspectivas terapêuticas. Realizamos uma revisão da literatura, selecionando artigos nas bases de dados Medline e Bireme, a partir dos unitermos: "non-epileptic seizures", "psychogenic seizures". As crises não-epilépticas (CNE) podem ser classificadas em fisiológicas (síncope, migrânea, ataque isquêmico transitório) e em psicogênicas (voluntárias ou não). O padrão-ouro para a diferenciação entre as crises epilépticas e as CNE é o videoeletroencefalograma, mas vários dados semiológicos podem auxiliar esse processo. O tratamento das CNE baseia-se em psicoterapia e em farmacoterapia direcionadas aos transtornos psiquiátricos comórbidos. Apesar de a alta prevalência das CNE e de sua elevada morbidade, são escassos os estudos na literatura nacional. São muitos os desafios diagnósticos e terapêuticos. Assim, o psiquiatra atentar-se à sua ocorrência, evitando iatrogenia, como o uso desnecessário de drogas antiepilépticas.
To discuss paroxysmal events that mimic epileptic seizures with emphasis on their semiologic differences and therapeutic perspectives. We did a narrative review of the literature based on selected papers in Medline and Bireme after searching for the uniterms "non-epileptic seizures" and "psychogenic seizures". Nonepileptic seizures (NES) can be classified in physiological (syncope, migraine, transitory ischemic attack) and psychogenic (voluntary or involuntary). The gold-standard in the differentiation of epileptic and nonepileptic seizures is the video-electroencefalogram, but many semiologic features can contribute to this process. The treatment of NES is based mainly on psychotherapy and pharmacotherapy directed to comorbid psychiatric disorders. Despite the high prevalence and elevated morbidity of the NES, there are just few studies on this subject in the Brazilian literature. There are many diagnostic and therapeutic challenges related to NES. Hence, psychiatrists should be aware of the occurrence of NES, avoiding iatrogenic interventions such as the unnecessary administration of anti-epileptic drugs.