Crises não epiléticas psicogénicas em doentes avaliados numa Unidade de Monitorização de Epilepsia

Abstract

Psychogenic Nonepileptic Seizures (PNES) in patients evaluated in an Epilepsy Monitoring Unit Diogo Silva1, Leonor Dias1,2, Marta Carvalho1,2, Ricardo Rego2,3, Helena Rocha2,3 1-Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto 2-Department of Neurology, Centro Hospitalar Universitário de São João, EPE 3-Neurophysiology Unit, Department of Neurology, Centro Hospitalar Universitário de São João, EPE Introduction: Psychogenic nonepileptic seizures (PNES) are paroxysmal events often confused with seizures. Misdiagnosis can lead to inappropriate treatment with antiseizure drugs (ASD). Video-electroencephalogram monitoring (VEM) in an Epilepsy Monitoring Unit (EMU) allows optimizing the diagnosis and consequently the treatment. Aim: to characterize a cohort of patients with PNES evaluated in the EMU and to assess the clinical outcome after VEM. Methods: Retrospective descriptive analysis of patients with PNES evaluated in the EMU between 2011-2020. Results: Of the 456 VEM performed, we included 28, totaling 64 PNES (mean 2/patient). The mean duration of VEM was 48h (SD 28.4). Most were female (86%) with a mean age of 41 years (SD 14.3). The mean age of PNES onset was 32 years (6-60 years), with a mean time to diagnosis of 12 years (SD 10.3). Most patients had motor and non-motor events (60.9%). The movements were mostly focal (85.7%), non-rhythmic (53.6%) and with alternating patterns (42.9%). Pelvic thrusting was rare (7%). Fifteen patients (54%) did not identify precipitants. At the time of VEM, 12 (42.9%) patients were diagnosed as having epilepsy only. Ninety-six percent of patients were on ASD, which were multiple in 64%. After VEM, 18 (64.2%) patients changed their diagnosis and 46% discontinued ASD. During follow-up (mean 3.5 years; SD 2.4), 36% of patients reported symptomatic improvement and 11% resolution of PNES. Conclusion: Analysis of paroxysmal events during VEM combined with patient history allowed a more accurate diagnosis of PNES, leading to discontinuation of ASD in almost half of patients.