Crisis no epilépticas psicógenas: Semiología en una cohorte de pacientes de una unidad de epilepsia de referencia nacional en Lima, Perú / Non-epileptic psychogenic seizures: semiology in a patient's cohort from a national reference epilepsy unit in Lima, Peru

RESUMEN Objetivo : Describir la semiología de crisis no epilépticas psicógenas (CNEP) en pacientes diagnosticados mediante videoelectroencefalograma (VEEG) en un centro nacional de epilepsia. Material y métodos : Estudio observacional, descriptivo y retrospectivo que incluyó a pacientes mayores de 14 años, ingresados a monitoreo de telemetría en el Hospital Nacional Edgardo Rebagliati Martins en Lima, Perú, entre el 1 de enero de 2017 y el 31 de diciembre de 2022, y definitivamente diagnosticados con CNEP mediante VEEG. Resultados : La mayoría de los 26 pacientes (20 mujeres y 6 varones) presentó pérdida de postura con caída (92 %), así como una instauración gradual (88 %) y cursaron con algún grado de alteración de conciencia o responsividad durante el evento (73 %). Los signos motores más prevalentes fueron movimientos asincrónicos de tronco y/o extremidades (73 %), fluctuación en la actividad motora (73 %), temblor global o en extremidades (54 %) y cierre palpebral forzado (50 %). Las manifestaciones clínicas no motoras fueron, en su mayoría, síntomas subjetivos (34 %). La mayoría (73 %) presentó CNEP motoras (73 %), en comparación con otras manifestaciones no motoras (12 %) y mixtas (15 %). Conclusiones : Los eventos clínicos descritos fueron de larga duración e instauración gradual y mostraron alteraciones de conciencia/responsividad. Los signos clínicos motores más frecuentes fueron movimientos asincrónicos de tronco y/o extremidades, fluctuación motora, temblor y cierre palpebral forzado. Los hallazgos no motores fueron, en su mayoría, síntomas subjetivos. La mayoría de los pacientes presentaron CNEP motoras.

ABSTRACT Objective : To describe the semiology of Psychogenic Non-Epileptic Seizures (PNES) in patients diagnosed by video-electroencephalogram (VEEG) in a national epilepsy center. Methods : An observational, descriptive, and retrospective study of patients older than 14 years, admitted for telemetry monitoring at the Epilepsy Unit of the National Hospital Edgardo Rebagliati Martins in Lima, Peru, between January 1st, 2017, and December 31, 2022. A definitive diagnosis of PNES was reached through VEEG. Results : Twenty of 26 studied patients were female and 6 male. Most patients experienced loss of posture with falls (92%), gradual onset (88%), some degree of altered consciousness or responsiveness during the event (73%). The most prevalent motor signs included asynchronous movements of the trunk and/or extremities (73%), fluctuation in motor activity (73%), global or limb tremors (54%), and forced eyelid closure (50%). Non-motor signs were predominantly subjective symptoms (34%). Most of the patients presented motor PNES (73%) compared to non-motor (12%) and mixed (15%). Conclusions : The described clinical events had a prolonged duration, gradual onset, and altered levels of consciousness/responsiveness. The most frequent clinical motor signs were asynchronous movements of the trunk and/or extremities, motor fluctuation, tremors, and forced eyelid closure. Non-motor findings were, primarily, subjective symptoms. Most of the patients presented motor PNES.

Calidad de vida en pacientes con epilepsia y crisis no epilépticas psicógenas: una revisión sistemática / Quality of life in patients with epilepsy and psychogenic nonepileptic seizures: a systematic review

Resumen Se han revisado artículos que estudiaron la calidad de vida en las personas con crisis no epilépticas psicógenas (CNEP) y crisis epilépticas. Se siguió la guía PRISMA y, previo a la búsqueda, se realizó un protocolo publicado en PROSPERO. Se incluyeron estudios aleatorizados y no aleatorizados, de tipo cuantitativo o mixtos, de corte transversal o longitudinal, escritos en lengua inglesa o española publicados hasta el año 2020, y cuyos participantes fueran mayores de 16 años. Luego de filtrar los resultados según los criterios de selección, se incluyeron 11 artículos y una tesis doctoral cuyos años de publicación datan de 1998 a 2020. En su mayoría, se informaba que las personas con CNEP tenían menor calidad de vida, asociadas a presencia de psicopatología, así como también a la toma de medicación antiepiléptica, factores sociodemográficos y relacionados con las crisis (frecuencia, severidad y duración de enfermedad), funcionamiento familiar, trauma y somatización.

Abstract Psychogenic non epileptic seizures (PNES) are disruptive changes in behaviour, thought, or emotion that resemble an epileptic seizure, but without paroxysmal neuronal discharge detectable by electroencephalography (EEG), and are not caused by another medical condition. On the other hand, epileptic seizures (ES) are defined as clinical events that reflect the presence of hypersynchronous discharges of neurons located in the cerebral cortex, which have the particularity of starting and ending abruptly. The diagnosis of epilepsy is made when an epileptic seizure was experienced and there is a risk of having another. The objective of this paper is to present the results of a systematic review of articles that have studied quality of life in people with PNES and ES. This review has been performed following the PRISMA guide (Preferred Reporting Items for Systematic reviews and Meta-Analyses). Prior to the beginning of the search, a protocol was carried out and it is published for consultation in the International prospective register of systematic reviews (PROSPERO). The review includes randomized and non-randomized, quantitative or mixed, cross-sectional or longitudinal studies, published in English or Spanish until 2020. In addition, participants had to be over 16 years old. PNES diagnosis must have been confirmed by video-electroencephalography (VEEG) or a similar procedure-which is considered the gold standard for the diagnosis of PNES.

Eventos no epilépticos psicógenos: El desafío constante de su diagnóstico y tratamiento / Psychogenic non epileptic events: The constant challenge of its diagnosis and treatment

Resumen Los eventos no epilépticos psicógenos (ENEP) son episodios paroxísticos descritos como cambios conductuales, alteraciones sensorio-sensitivas, o manifestaciones motoras que se asemejan a las crisis epilépticas pero sin mostrar actividad epileptiforme subyacente, no son producidos deliberadamente por el individuo, y responden a mecanismos multifactoriales de índole biopsicosocial. La información epidemiológica es limitada debido a la naturaleza heterogénea de la población afectada, así como a la escasa accesibilidad al videoelectroencefalograma (vEEG) necesario para su diagnóstico. En este contexto, es necesaria la convergencia de dos elementos importantes: historia clínica detallada (características clínicas sugerentes de ENEP e identificación de los factores asociados) y la ausencia de cambios electroencefalográficos en el vEEG durante el episodio. La evaluación psicológica provee información adicional relevante para la corroboración diagnóstica y para su manejo. El diagnóstico debe realizarse de manera oportuna, para evitar complicaciones en su evolución y tratamiento. Es vital una actitud positiva y alentadora hacia el/la paciente al momento de comunicarle su diagnóstico, así como la coordinación entre el neurólogo tratante y los profesionales de salud mental involucrados en el manejo y seguimiento del caso. La psicoterapia cognitiva conductual, asociada a psicofármacoterapia -cuando pertinente-, constituyen el tratamiento más eficaz de estos pacientes. Existen limitados estudios en Latinoamérica sobre aspectos epidemiológicos y clínico-evolutivos de pacientes con ENEP, por lo que más investigación y publicaciones respecto a esta problemática son indispensables dado su impacto sobre la calidad de vida de los pacientes y sobre el costo de su manejo en los sistemas de salud.

Summary Psychogenic Non-Epileptic Events (PNEE) are paroxysmal episodes described as behavioral changes, sensory- sensitive disturbances, or motor manifestations that resemble epileptic seizures without showing underlying epileptiform activity, are not deliberately produced by the individual, and respond to multifactorial biopsychosocial mechanisms. Epidemiological information is limited due to the heterogeneous nature of the affected population, and to the limited accessibility to the video electroencephalogram (vEEG) necessary for its diagnosis. In such context, the convergence of two important elements is necessary: a detailed clinical history (clinical characteristics suggestive of PNEE, and identification of the associated factors), and the absence of electroencephalographic "ictal" changes in the vEEG. A psychological evaluation provides additional information, relevant for the diagnostic corroboration and management. The diagnosis must be made in a timely manner, to avoid complications in its evolution and treatment. A positive and encouraging attitude to the patient is vital when informing him/her of the diagnosis, as it also is the coordination between the treating neurologist and mental health professionals involved in the management and monitoring of the case. Cognitive behavioral psychotherapy, associated with psychopharmacotherapy -when needed-- constitute the most effective treatment approach for these patients. There are limited studies on the current epidemiological and clinical evolution of patients with PNEE in Latin America, and additional research regarding this problem is much needed, given its impact on the quality of life of the patients and on the cost of its management in the health care systems.

Pseudoseizures with urinary incontinence in a child with Neuromyelitis optica: a rare association

Background: Paroxysmal non epileptic events or pseudoseizures are common seizure mimics in children. But occasionally PNES events can present or coexist along with organic neurological disorders complicating the clinical scenario posing great challenges for diagnostic and therapeutic implications. Unusual symptomatology in PNES like frothing, tongue bite or urinary incontinence can be seen in PNES. Here, we present a rare case of pseudoseizures with urinary incontinence in a child with Neuromyelitis optica which posed a challenge for diagnosis and proper management with a favourable clinical outcome. A 14 years old girl who was known diagnosed case of Neuromyelitis optica on treatment with oral steroids presented with a history of repeated attacks of involuntary movements affecting all four limbs preceded by a feeling of fear and pain and these events were associated with urinary incontinence. Electroencephalogram and magnetic resonance imaging were performed on the patient. Ictal video EEG confirmed the diagnosis of pseudoseizures. Neuropsychological evaluation was performed which revealed multiple psychological stressors. Repeated counseling sessions and psychotherapy provided significant improvement in the form of remission of pseudoseizures.

Modelos conceptuales y explicativos sobre las crisis no epilépticas psicógenas (CNEP) / Conceptual and explanatory models of Psychogenic Non-Epileptic Seizures (PNES)

Las Crisis No Epilépticas Psicógenas (CNEP) son episodios similares a las crisis epilépticas, pero a diferencia de éstas, no son causadas por la actividad eléctrica anómala del cerebro. Se diagnostican una vez descartadas otras causas fisiopatológicas. El objetivo de este artículo es presentar la conceptualización actual de este fenómeno. Para ello, en primer lugar realizaremos una historización del fenómeno, relacionándolo con la categoría de histeria; segundo lugar, describiremos las clasificaciones propuestas por las distintas ediciones del Manual Diagnóstico y Estadístico de los trastornos mentales, destacando su última versión (DSM-V); finalmente, introduciremos las corrientes actuales que explican este fenómeno, las cuales toman el rol de la disociación como categoría central que explica tanto el diagnóstico así como los objetivos de tratamiento para las CNEP. La categoría disociación es la clave para entender la dirección en la que se está avanzando en psicopatalogía, la búsqueda de los procesos psicológicos específicos subyacentes para entender el mecanismo que lleva a producir tanto las CNEP como otros cuadros de psicopatológicos.

Psychogenic Non Epileptic Crises (CNEP) have been a challenge to diagnostic and explanation for the mental health field. They are diagnosed after discard out other pathophysiological causes of the crisis. They are similar to epileptic seizures, but unlike these, they are not caused by electrical activity in the brain. In order to present the current conceptualization of this phenomenon, we propose in first place to describe its historical development, second, the current classification of the Diagnostic and Statistical Manual (DSM-V), third, to introduce the present currents that explain this phenomenon by taking the role of dissociation as a central category that explains the diagnosis and the treatment objectives for the CNEP. The dissociation category is the key to understand the direction in which progress is being made in psychopathology, the search for the specific underlying psychological processes to understand the mechanism that leads to producing both the CNEP and other psychopathological frames.

Paroxysmal non-epileptic motor phenomena in newborns / 国际儿科学杂志

A variety of paroxysmal motor phenomena often occur in newborns,including physiological events(immaturity of the central nervous system) and pathological events(epileptic and non-epileptic).The clini cian should be able to properly identify and diagnose the paroxysmal motor phenomena with various etiologies.There are some clinical features that may help clinicians with the diferentation among physiological and pathological,epileptic and non-epileptic events.However,VEEG monitoring is still the gold standard for differentiating the paroxysmal motor phenomena of epileptic and non-epileptic seizures,which can help to further clarify the etiology.In this paper,the clinical features,underlying pathophysiological mechanisms and differential diagnoses of non-epileptic paroxysmal motors in newborns were reviewed.

Eventos Críticos en el Recién Nacido / Newborn Critical Events

El periodo neonatal corresponde a una etapa en el desarrollo en el que las convulsiones constituyen la expresión clínica de disfunción del sistema nervioso central. Estas se manifiestan por una alteración en la función neurológica que puede ser motora, autonómica, de la conducta o una combinación de ellas. Dado que en este periodo el desarrollo anatómico, bioquímico y fisiológico, presentan características muy diferentes al desarrollo del niño mayor, las convulsiones pueden ser muy difíciles de identificar y pueden confundirse con eventos clínicos paroxísticos no epilépticos del recién nacido. Lo anterior se explica porque las convulsiones presentan patrones poco organizados, suelen no ser bien definidas y el registro electroencefalográfico es diferente al del niño mayor. En su mayoría las CN son secundarias a una etiología específica, por lo que es indispensable encontrar la causa lo cual se encuentra fuertemente relacionado al pronóstico. También es necesario diferenciar los eventos no epilépticos, para un óptimo manejo. Palabras clave: convulsiones neonatales, newborn, seizures, non epileptic seizures, disfunción cerebral.

The neonatal period corresponds to a developmental stage in which seizures are the clinical expression of central nervous system dysfunction. These are manifested by a change in neurological function that can be motor, autonomic, behavior or a combination of them.Given that in this period the anatomical, biochemical and physiological development present with very different characteristics to those of the older child, seizures can be very difficult to identify, and can be confused with paroxysmal non epileptic clinical events of the newborn. This is explains why seizures have little organized patterns are often not well defined and the Electroencephalographic record is different from that found in the older child. For the most part, neonatal seizures are secondary to a specific etiology, so it is essential to find the cause, which is strongly related to the prognosis. It is also necessary to differentiate non-epileptic events, for optimal handling. Key words: Neonatal seizures, neonatal, non epileptic seizures, brain dysfunction.

Psychogenic non-epileptic seizures and psychoanalytical treatment: results / Crises não epilépticas psicogênicas e tratamento psicanalítico: resultados.

Background: the occurrence of psychogenic non-epileptic seizures (PNES) is estimated to be between 2 to 33 cases in every 100,000 inhabitants. The number of patients with PNES reaches 19% of those treated as epileptics. Patients with PNES are treated as if they had intractable epilepsy, with unsatisfactory results even after medication treatment is used to its maximum. The aim of this study is to present the effects of individual psychoanalytical treatment in patients with PNES, assessing its impact in the evolution of the clinical picture and its association with sex, time of disease, social, psychological and professional harm, as well as going through with treatment. Methods: The case base was composed of 37 patients with PNES. The diagnosis was reached with video-EEG monitoring. Psychoanalytical treatment was carried out through 12 months of weekly sessions timed for around 50-minutes each, in a total of 48 individual sessions. Results: This study found a high rate of success in the treatment of PNES patients. 29.7% (n=11) of patients had cessation or cure of symptoms and 51.4% (n=19) had a decrease in the number of episodes. There is an association between cessation or decrease in the number of episodes and sex (p<0.01), religion (p<0.01) and concluding treatment (p<0.01). Conclusion: Individual psychoanalytical treatment applied to patients with PNES is considered effective and can be an essential form of assistance for the reduction or cessation of episodes. .

Introdução: estima-se que o número de casos de pacientes com crises não epilépticas psicogênicas (CNEP) seja de 2 a 33 por 100 mil habitantes. O índice de CNEP corresponde ainda a, aproximadamente, 19% dos pacientes tratados como epilépticos. Os pacientes com CNEP são tratados como portadores de epilepsia refratária, chegando ao limite máximo do tratamento medicamentoso e sem a obtenção de resultados satisfatórios. Objetivo: relatar os efeitos do tratamento psicanalítico individual em pacientes com CNEP de forma a avaliar a evolução do quadro clínico de CNEP e verificar sua associação com gênero, tempo de crise, prejuízos sociais, afetivos e profissionais, bem como término do tratamento. Métodos: a casuística foi composta por 37 pacientes com diagnóstico de CNEP feito por meio da monitoração por vídeo-EEG. Foram realizadas sessões de tratamento psicanalítico: atendimento clínico individual com frequência semanal, com duração aproximada de 50 minutos e duração total de 48 sessões em 12 meses. Resultados: este estudo constatou elevado índice de sucesso no tratamento dos pacientes com CNEP: 29,7% (n = 11) de cessação/cura dos sintomas e 51,4% (n = 19) de redução das crises convulsivas. Foi constatada associação entre cessar ou reduzir as crises e gênero (p<0,01), religião (p<0,01) e término do tratamento (p<0,01). Conclusão: este estudo apontou eficácia do tratamento psicanalítico individual realizado com pacientes com CNEP, podendo ser considerada uma forma de assistência essencial para que haja decréscimo ou cessação das crises. .

Value of video-electroencephalography for the diagnosis of children with non-epileptic seizures / 中国医师进修杂志

Objeaive To study the value ofvideo-electroencephalography(VEEG) for the diagnosis of children with non-epileptic seizures (NES).Methods A retrospective analysis was carried out in 280 patients with NES diagnosed by VEEG surveillance.All the patients underwent routine electroencephalography (EEG),VEEG,CT and MRI examination.Results Routine EEG was normal in 183 cases,and abnormal in 97 cases.VEEG recording was normal in 207 cases(73.9％,207/280),and abnormal in 73 cases(26.1％,73/280).The somatic NES was in 210 cases (75.0％,210/280),and psychogenic NES was in 70 cases (25.0％,70/280).NES combined with epilepsy were in 22 cases,MRI found 20 cases (90.9％,20/22) and head CT found 14 cases (63.6％,14/22).In the combined diagnosis,MRI was higher than CT in detecting focus (P ＜ 0.05).Conclusions VEEG is the important means of diagnosing children with NES,which is also important to differentiate with epilepsy.Combined with cranial imaging studies,it improves the identification of abnormal discharge and epilepsy,and further reveals the structural features of the epileptic discharge lesions is an important qualitative means of epilepsy etiological diagnosis.

Das Unheimliche no corpo: reflexões a partir da crise pseudoepiléptica / Das Unheimliche in the body: reflections based on non-epileptic seizures / Das Unheimliche en el cuerpo: reflexiones a partir de la crisis pseudo epilépticas

O trabalho trata da sensação de inquietante estranhamento referida por pacientes diagnosticados com crises pseudoepilépticas em relação ao seu corpo. Aproveitando-se dos estudos de Freud a propósito do Unheimliche no campo da estética, o trabalho aborda o conceito em seu potencial clínico e apresenta um fragmento de caso em que tal sentimento está presente e é valorizado em análise. O caso clínico apresenta tanto o conceito de Unheimliche funcionando clinicamente, quanto a clínica da histeria, ainda viva em suas manifestações mais espetaculares.

This paper is about the uncanny feeling about their own body, referred to by patients diagnosed with non-epileptic seizures. Based on Freud’s studies of the Unheimliche on the aesthetic field, this paper brings the concept of its clinical potential and presents a fragment of a case in which such felling is presented and analyzed. The clinical case presents both the concept of the Unheimliche working clinically and the hysteria, still alive in its most spectaculars manifestations.

El trabajo trata de la sensación de inquietante extrañeza narrada por los pacientes diagnosticados con crisis pseudo-epilépticas en relación a su cuerpo. Partiendo de los estudios de Freud, a propósito de lo Unheimliche en el campo de la estética, el trabajo aborda el concepto en su potencial clínico y presenta un fragmento de caso en que tal sentimiento está presente y es valorizado en el análisis. El caso clínico escogido presenta tanto el concepto de Unheimliche en su aplicación clínica, cuanto la clínica de la histeria, aún viva en sus manifestaciones más espectaculares.

Crise não epiléptica psicogênica: história e crítica de um conceito / Psychogenic non-epileptic seizures: history and critique of a concept

Discute o desenvolvimento do conhecimento psiquiátrico sobre a crise não epiléptica psicogênica (CNEP), buscando iluminar os pressupostos epistemológicos do conceito e suas implicações práticas. Em sua definição atual, crises ou ataques recorrentes são manifestações comportamentais semelhantes às da epilepsia, mas que dela diferem por não serem consequentes de descargas elétricas cerebrais anormais, podendo ter origem psicogênica. Em direção inversa da metafísica, investiga-se a emergência histórica do conceito de CNEP nos últimos quarenta anos. Conceitos de comorbidade psiquiátrica, abuso e dissociação foram discutidos devido a sua participação na trajetória conceitual de CNEP.

This discussion of the evolution of psychiatric knowledge concerning psychogenic non-epileptic seizures (PNES) sheds light on the epistemological assumptions underlying the concept and on its practical implications as well. PNES are defined as repeated seizures or attacks which can be mistaken for epilepsy because of the similar behavioral changes displayed, but which differ in that they are not the result of abnormal electrical activity in the brain and may be psychogenic in origin. The article investigates the historical development of the concept of PNES over the past forty years. The concepts of psychiatric comorbidity, abuse, and dissociation enter the discussion owing to their roles in the checkered development of the concept of PNES.

Characteristics of Psychogenic Non-Epileptic Seizure Patients using MMPI Profiles

PURPOSE: The purpose of this study was to know psychological characteristics of psychogenic non-epileptic seizure (PNES) patients by analyzing profiles of Minnesota Multiphasic Personality Inventory (MMPI). In addition, we tried to investigate whether there are differences of MMPI profiles, depending on the gender and age.METHODS: We included 65 patients with non-epileptic psychogenic seizures. Their diagnosis was based on clinical features, provocative test and confirmed by video-EEG monitoring.RESULTS: The results of MMPI analysis did not show any statistically significant differences of quantitative scoring on the main clinical scales. However, additional analysis indicated that patients with PNES had some characteristics of more somatic complaints and depressive mood. According to sex difference, the MMPI profiles of female group showed an increase in the depression scale (D-Pt), whereas those of male group revealed an increased in the somatisation (Hs-Hy). According to age difference, MMPI profiles of adolescent group had the characteristics of personality pattern with a tendency toward somatisation. MMPI profiles of adult group had more depressive tendency. This study suggests that profiles of MMPI, according to the gender and age, can have different characteristics.CONCLUSIONS: Clinical consideration of those factors may be helpful for improving the care of PNES patients.

Characteristics of Psychogenic Non-Epileptic Seizure Patients using MMPI Profiles / 대한간질학회지

PURPOSE: The purpose of this study was to know psychological characteristics of psychogenic non-epileptic seizure (PNES) patients by analyzing profiles of Minnesota Multiphasic Personality Inventory (MMPI). In addition, we tried to investigate whether there are differences of MMPI profiles, depending on the gender and age. METHODS: We included 65 patients with non-epileptic psychogenic seizures. Their diagnosis was based on clinical features, provocative test and confirmed by video-EEG monitoring. RESULTS: The results of MMPI analysis did not show any statistically significant differences of quantitative scoring on the main clinical scales. However, additional analysis indicated that patients with PNES had some characteristics of more somatic complaints and depressive mood. According to sex difference, the MMPI profiles of female group showed an increase in the depression scale (D-Pt), whereas those of male group revealed an increased in the somatisation (Hs-Hy). According to age difference, MMPI profiles of adolescent group had the characteristics of personality pattern with a tendency toward somatisation. MMPI profiles of adult group had more depressive tendency. This study suggests that profiles of MMPI, according to the gender and age, can have different characteristics. CONCLUSIONS: Clinical consideration of those factors may be helpful for improving the care of PNES patients.

Epilepsy in patients with psychogenic non-epileptic seizures / Epilepsia em pacientes com crises não epilépticas psicogênicas

The aim of this study was to evaluate the frequency of epilepsy in patients who presented psychogenic non-epileptic seizures (PNES). The evaluation was carried out during intensive VEEG monitoring in a diagnostic center for epilepsy in a university hospital. The difficulties involved in reaching this diagnosis are discussed. Ninety-eight patients underwent intensive and prolonged video-electroencephalographic (VEEG) monitoring; out of these, a total of 28 patients presented PNES during monitoring. Epilepsy was defined as present when the patient presented epileptic seizures during VEEG monitoring or when, although not presenting epileptic seizures during monitoring, the patient presented unequivocal interictal epileptiform discharges. The frequency of epilepsy in patients with PNES was 50 percent (14 patients). Our findings suggest that the frequency of epilepsy in patients with PNES is much higher than that of previous studies, and point out the need, at least in some cases, for prolonging the evaluation of patients with PNES who have clinical histories indicating epilepsy.

O objetivo deste estudo foi avaliar a frequência de epilepsia em pacientes que apresentaram crises não epilépticas psicogênicas (CNEP). Isto foi realizado durante monitoração intensiva por video-EEG num centro diagnóstico de epilepsia em um hospital universitário. As dificuldades envolvidas para se chegar a este diagnóstico são discutidas. Noventa e oito pacientes foram submetidos a monitoração intensiva por video-EEG; 28 destes pacientes apresentaram CNEP durante a monitoração. Epilepsia foi considerada presente quando o paciente apresentou crises epilépticas durante a avaliação pelo video-EEG ou quando, apesar da não ocorrência de crises epilépticas durante a avaliação, descargas epilépticas interictais inequívocas estavam presentes. A frequência de epilepsia em pacientes com CNEP foi 50 por cento (14 pacientes). Nossos achados sugerem que a frequência de epilepsia em pacientes com CNEP é maior do que a apresentada em estudos anteriores e apontam para a necessidade de, ao menos em alguns casos, prolongar a avaliação de pacientes com CNEP, mas com história clínica sugestiva de epilepsia.

Movement-induced heart rate changes in epileptic and non-epileptic seizures / Alterações da frequência cardíaca induzidas pelo movimento em crises epilépticas e não-epilépticas

Heart rate changes are common in epileptic and non-epileptic seizures. Previous studies have not adequately assessed the contribution of motor activity on these changes nor have evaluated them during prolonged monitoring. We retrospectively evaluated 143 seizures and auras from 76 patients admitted for video EEG monitoring. The events were classified according to the degree of ictal motor activity (severe, moderate and mild/absent) in: severe epileptic (SE, N=17), severe non-epileptic (SNE, N=6), moderate epileptic (ME, N=28), moderate non-epileptic (MNE, N=11), mild epileptic (mE, N=35), mild non-epileptic (mNE, N=33) and mild aura (aura, N=13). Heart rate increased in the ictal period in severe epileptic, severe non-epileptic, moderate epileptic and mild epileptic events (p<0.05). Heart rate returned to baseline levels during the post ictal phase in severe non-epileptic seizures but not in severe epileptic patients. Aura events had a higher baseline heart rate. A cut-off of 20 percent heart rate increase may distinguish moderate epileptic and mild epileptic events lasting more than 30 seconds. In epileptic seizures with mild/absent motor activity, the magnitude of heart rate increase is proportional to the event duration. Heart rate analysis in seizures with different degrees of movement during the ictal phase can help to distinguish epileptic from non-epileptic events.

Alterações da frequência cardíaca são comuns em crises epilépticas e não-epilépticas. Estudos prévios não avaliaram adequadamente a contribuição da atividade motora nas alterações da frequência cardíaca, e as crises não foram estudadas durante monitoração prolongada. No presente estudo avaliamos retrospectivamente 143 crises de 76 pacientes admitidos para monitoração com vídeo-EEG no Hospital da Universidade de Saint Louis. As crises foram classificadas de acordo com o grau de atividade motora (severa, moderada e leve/ausente) em: epiléptica grave (EG, N=17), não-epiléptica grave (NEG, N=6), epiléptica moderada (EM, N=28), não epiléptica moderada (NEM, N=11), epiléptica leve (EL, N=35), não-epiléptica leve (NEL, N=33), e aura, N=13. A frequência cardíaca aumentou no período ictal nas crises epilépticas graves, não epilépticas graves, epilépticas moderadas, epilépticas leves (p<0,05). A frequência cardíaca apresentou tendência a retornar aos níveis basais durante o período pós ictal nas crises não epilépticas graves, mas não nas crises epilépticas graves. As auras apresentaram frequência cardíaca basal aumentada. Um limiar de 20 por cento no aumento da frequência cardíaca pode diferenciar eventos epilépticos moderados de eventos epilépticos leves com duração maior que 30 segundos. Em crises epilépticas com atividade motora leve ou ausente, a magnitude do aumento da frequência cardíaca é proporcional à duração do evento. A análise da frequência cardíaca em crises com diferentes quantidades de movimento na fase ictal podem ajudar na diferenciação de crises epilépticas de não epilépticas.