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The first-line management of psychogenic non-epileptic seizures(PNES)in adults in the emergency:a practical approach

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Acta Epileptologica 2020年第1期2卷 48-58页

作者： Dènahin Hinnoutondji Toffa Laurence Poirier Dang Khoa Nguyen Neurosciences Division Centre de Recherche du Centre Hospitalier de l’Universitéde Montréal900 Rue Saint-DenisMontreal(QC)H2X 0A9Canada. Neurology Department Centre Hospitalier de l’Universitéde MontréalMontrealQuebecCanada. Faculty of Medicine McGill UniversityMontrealCanada.

Distinguishing non-epileptic events,especially psychogenic non-epileptic seizures(PNES),from epileptic seizures(ES)constitutes a diagnostic *** are frequent,especially when video-EEG recording,the gold-standard for PNES confirmation,cannot be *** issue is further complicated in cases of combined PNES with *** emergency units,a misdiagnosis can lead to extreme antiepileptic drug escalade,unnecessary resuscitation measures(intubation,catheterization,etc.),as well as needless biologic and imaging *** of the acute window,an incorrect diagnosis can lead to prolonged hospitalization or increase of unhelpful antiepileptic drug *** recognition is thus desirable to initiate adequate treatment and improve *** experience-based strategies and a thorough review of the literature,we aimed to present the main clinical clues for physicians facing PNES in non-specialized units,before management is transferred to epileptologists and *** such conditions,patient recall or witness-report provide the first orientation for the diagnosis,recognizing that collected information may be *** analysis of an event(live or based on home-video)may lead to a clinical diagnosis of PNES with a high confidence ***,a fluctuating course,crying with gestures of frustration,pelvic thrusting,eye closure during the episode,and the absence of postictal confusion and/or amnesia are highly suggestive of ***,induction and/or inhibition tests of PNES have a good diagnostic value when *** may also be a useful biomarker to distinguish PNES from epileptic seizures,especially following bilateral tonic-clonic ***,regardless the level of certainty in the diagnosis of the PNES,it is important to subsequently refer the patient for epileptological and neuropsychiatric follow-up.

关键词： Psychogenic non-epileptic seizures(PNES) Epilepsy Emergency Pseudostatus Prolactin dosage homemade video

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