The evaluation of psychogenic non-epileptic seizures (PNES) cases with saline injection method in video-EEG monitorization unit

ABSTRACT Background: It has been reported that 10 to 30% of patients sent to epilepsy centers with a diagnosis of refractory epilepsy are diagnosed with psychogenic non-epileptic seizure (PNES). A wide variety of provocative methods are used to assist PNES diagnosis. Objective: To investigate the effect of seizure induction on the diagnosis and prognosis of PNES. Methods: We retrospectively examined 91 patients with PNES complaints in our video-EEG laboratory. Intravenous saline was administered to all patients for induction of seizures. Results: Saline injection was performed in 91 patients referred to our EEG lab with PNES initial diagnosis, 57 of whom were female and 34 male. Saline injection triggered an attack in 82 patients (90%). Conclusions: In this study we have concluded that provocative methods are practical, cheap and, most of all, effective for patient diagnosis. In clinical practice, explaining the diagnosis is the first and most important step of the treatment, and careful patient-doctor communication has a positive impact on patient prognosis.

摘要 背景：据报道，在转诊至癫痫中心、初始诊断为难治性癫痫的患者中，有10%至30%实际被诊断为心因性非癫痫性发作（psychogenic non-epileptic seizure, PNES）。目前临床应用多种诱发手段辅助PNES的诊断。目的：探讨发作诱发手段对心因性非癫痫性发作（PNES）的诊断及预后的影响。方法：本研究对本中心视频脑电图（video-EEG）实验室中91例主诉疑似PNES的患者进行了回顾性分析，所有患者均接受静脉生理盐水注射以诱发发作。结果：本研究共纳入91例初始诊断疑似PNES并转诊至脑电图实验室的患者，其中女性57例，男性34例；静脉生理盐水注射成功诱发82例患者出现发作，诱发率达90%。结论：本研究证实，发作诱发手段具备实用性强、成本低廉且诊断效能尤为突出的优势。临床实践中，向患者充分告知诊断结果是治疗的首要且核心步骤，细致的医患沟通对改善患者预后具有积极作用。