En mann i 40-årene med flere krampeanfall

Abstract

A man in his forties had been repeatedly assessed over a period of 15 years at neurological departments and specialised epilepsy hospitals. The conclusion was always psychogenic, non-epileptic seizures (PNES), but there were no proposals for treatment. Prior to the current treatment he had also undergone several psychiatric assessments, which found the seizures to be dissociative and consistent with psychogenic, non-epileptic seizures. Psychotherapeutic and medical approaches had been ineffective. Alcohol is known to trigger seizures, exacerbate seizure control in epilepsy patients or induce epilepsy. In every third acute admission after an epileptic attack, more alcohol than normal has been consumed prior to the episode (1). Episodes triggered by fever are also common, but more frequent in children. As a rule these do not cause brain damage (2). Psychogenic, non-epileptic seizures can be defined as an observable, sudden seizure-like change in behaviour or consciousness which resembles an epileptic seizure but is not accompanied by the EEG changes that are characteristic of epileptic seizures or by other evidence of epilepsy or other somatic causes. However, many believe that cases of acute admissions with major, dramatic, GTC-like seizures where psychiatric examination does not reveal a mental disorder could be classified as conversion/dissociation. As a result these seizures are classified as dissociative/ psychogenic non-epileptic seizures.On three occasions he was assessed at specialised epilepsy centres. 24-hour, 26-channel

Psychogenic non-epileptic seizures: issues of comorbidity in the diagnosis and treatment

“…Разграничение эпилептических и неэпилептических приступов -важная задача практической неврологии и психиатрии. Ошибочная дифференциальная диагностика псевдоэпилептических приступов сопровождается неадекватным подходом к ведению таких пациентов [1][2][3]. Так, если пароксизмальные состояния неэпилептического характера наблюдаются и на фоне эпилепсии, то в случае неправильной диагностики это может приводить к неоправданной отмене противоэпилептических препаратов [4].…”

“…ПНП традиционно считаются патологическим состоянием, которое относится к компетенции психиатров [25]. Однако наш опыт свидетельствует, что такие пациенты часто оказываются вне помощи со стороны как неврологов, так и психиатров, вместо того, чтобы находиться в области их конструктивного взаимодействия в процессе диагностики и лечения [3].…”