Características demográficas, epileptológicas e psiquiátricas associadas à coexistência de epilepsia e crises não epilépticas psicogênicas
Autor(a) principal: | |
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Data de Publicação: | 2016 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da PUC_RS |
Texto Completo: | http://tede2.pucrs.br/tede2/handle/tede/6771 |
Resumo: | Title: Demographic, Epileptological and Psychiatric Features of Co-existing Psychogenic Non-epileptic Seizures and Epilepsy. Introduction: Psychogenic non-epileptic seizures (PNES) comprise the most important differential diagnosis in patients with suspected epileptic seizures (ES), but a clear diagnosis of either one does not preclude at all the other. This co-existence, which has a complex diagnosis and management, is a frequently overlooked co-morbidity, especially in patients with refractory epilepsy. A timely and proper diagnosis of this association reduces risks related to omission of one, improving quality of life and optimizing resources in health care. Objective: To investigate demographic, epidemiologic and psychiatric features suggestive of co-existing ES and PNES that may contribute to precocious suspicion of the association. Material and methods: In this prospective study, all patients older than 16 year admitted to epilepsy surgery program for investigation of seizures with prolonged video-electroencephalogram (V-EEG), from March 2014 to November 2015 were evaluated about demographic, epileptological and psychiatric characteristics. After evaluation, a total of 86 patients received a definitive diagnosis, within the following groups: ES only, PNES only and co-existing ES and PNES. Results: PNES was found in 29% of patients (n=25), with co-existence with ES was revealed in 52 % of these (n=13). Features associated to co-existence was more than one seizure type, temporal lone epilepsy with multifocal or bi-temporal epileptic discharges, and nonspecific white matter hyperintensities on MRI, along with a higher number of psychiatric diagnoses, somatoform disorders, generalized anxiety disorders, and a previous history of psychosis. Also, depression and anxiety levels during evaluation were associated to co-existing PNES and ES. Conclusion: The high prevalence of this co-existence reinforces a need to properly investigate PNES, especially in patients with confirmed ES who become refractory to medical treatment with antiepileptic drugs. The finding of temporal lobe epilepsy with bi-temporal or multifocal spikes associated to this co-existence differs from other studies and deserves to be further evaluated. A thorough anamnesis, focused on semiology of seizures and psychiatric issues contribute to heighten suspicion of the co-existence. Clinical features that suggest a more careful look include multiple seizure types, along with a high number of psychiatric diagnoses in a same patient, especially bipolar affective disorder, post-traumatic stress disorder and a previous history of psychosis, associated to higher levels of anxiety and depression during hospitalization are all highly suggestive of co-existing ES and PNES. This co-existing is common, frequently unsuspected and should not be undermined as a cause of refractory epilepsy and significant suffering for patients and caregivers. |
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Palmini, André Luis Fernandes371.383.160-20http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4782382H9511.068.410-34http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4771301Y5Baroni, Gislaine Verginia2016-06-15T18:47:19Z2016-03-03http://tede2.pucrs.br/tede2/handle/tede/6771Title: Demographic, Epileptological and Psychiatric Features of Co-existing Psychogenic Non-epileptic Seizures and Epilepsy. Introduction: Psychogenic non-epileptic seizures (PNES) comprise the most important differential diagnosis in patients with suspected epileptic seizures (ES), but a clear diagnosis of either one does not preclude at all the other. This co-existence, which has a complex diagnosis and management, is a frequently overlooked co-morbidity, especially in patients with refractory epilepsy. A timely and proper diagnosis of this association reduces risks related to omission of one, improving quality of life and optimizing resources in health care. Objective: To investigate demographic, epidemiologic and psychiatric features suggestive of co-existing ES and PNES that may contribute to precocious suspicion of the association. Material and methods: In this prospective study, all patients older than 16 year admitted to epilepsy surgery program for investigation of seizures with prolonged video-electroencephalogram (V-EEG), from March 2014 to November 2015 were evaluated about demographic, epileptological and psychiatric characteristics. After evaluation, a total of 86 patients received a definitive diagnosis, within the following groups: ES only, PNES only and co-existing ES and PNES. Results: PNES was found in 29% of patients (n=25), with co-existence with ES was revealed in 52 % of these (n=13). Features associated to co-existence was more than one seizure type, temporal lone epilepsy with multifocal or bi-temporal epileptic discharges, and nonspecific white matter hyperintensities on MRI, along with a higher number of psychiatric diagnoses, somatoform disorders, generalized anxiety disorders, and a previous history of psychosis. Also, depression and anxiety levels during evaluation were associated to co-existing PNES and ES. Conclusion: The high prevalence of this co-existence reinforces a need to properly investigate PNES, especially in patients with confirmed ES who become refractory to medical treatment with antiepileptic drugs. The finding of temporal lobe epilepsy with bi-temporal or multifocal spikes associated to this co-existence differs from other studies and deserves to be further evaluated. A thorough anamnesis, focused on semiology of seizures and psychiatric issues contribute to heighten suspicion of the co-existence. Clinical features that suggest a more careful look include multiple seizure types, along with a high number of psychiatric diagnoses in a same patient, especially bipolar affective disorder, post-traumatic stress disorder and a previous history of psychosis, associated to higher levels of anxiety and depression during hospitalization are all highly suggestive of co-existing ES and PNES. This co-existing is common, frequently unsuspected and should not be undermined as a cause of refractory epilepsy and significant suffering for patients and caregivers.Título: Características Demográficas, Epileptológicas e Psiquiátricas Associadas à Coexistência de Epilepsia e Crises Não Epilépticas Psicogênicas Introdução: Crise não epiléptica psicogênica (CNEP) é o principal diagnóstico diferencial em pacientes com epilepsia (CE), porém sua presença não exclui CE e vice-versa. Essa coexistência, cujo diagnóstico e tratamento são complexos, é uma comorbidade frequente, principalmente em pacientes com epilepsia considerada refratária ao tratamento. A suspeição e a confirmação desta coexistência reduzem os riscos envolvidos na omissão de qualquer um dos diagnósticos, reduzindo o impacto na vida pessoal e os custos em saúde. Objetivo: Investigar características demográficas, epidemiológicas e psiquiátricas sugestivas da coexistência de CE e CNEP que possam contribuir para a suspeição precoce. Material e métodos: Foram avaliados prospectivamente, pacientes acima de 16 anos, sequencialmente internados para monitorização através do vídeo-eletroencefalograma (V-EEG) de longa duração no período de março de 2014 a novembro de 2015, quanto às características demográficas, epileptológicas e psiquiátricas. Após a conclusão da investigação epileptológica, foi possível estabelecer um diagnóstico de certeza em 86 pacientes, divididos em 3 grupos: CE única, CNPE única, coexistência de CE e CNEP. Resultados: CNEP, foi diagnosticada em 29%(n=25) dos pacientes incluídos, e a coexistência foi encontrada em 52% destes (n=13). O relato de mais de um tipo de crise obtido através da anamnese, epilepsia de lobo temporal com descargas bilaterais ou multifocais e alterações inespecíficas da substância branca à RM, somado ao maior número de diagnósticos de transtornos psiquiátricos, incluindo transtorno somatoforme, TAB e história prévia de psicose, bem como elevados níveis de ansiedade e depressão durante a avaliação foram características sugestivas da associação de CE e CNEP comparado aos outros dois grupos. Conclusões: A alta prevalência da coexistência encontrada reforça a necessidade de investigar CNEP, principalmente em pacientes com CE confirmada, e naqueles considerados refratários ao tratamento com drogas antiepilépticas. Os achados eletroencefalográficos de alterações ictais e interictais temporais ou multifocais bilaterais foram relacionados à coexistência, e diferem de estudos anteriores. O conjunto da anamnese, focada nos principais aspectos epileptológicos, e a avaliação psiquiátrica, pode contribuir para a suspeição da coexistência. O relato de diferentes tipos de apresentação clinica das crises, somado ao diagnóstico de maior número de comorbidades psiquiátricas num mesmo individuo, destacando-se transtorno afetivo bipolar, transtorno de estresse pós-traumático e história pregressa de transtorno psicótico, associado a níveis mais elevados de ansiedade e depressão durante a internação são sugestivos da associação de CE e CNEP.Submitted by Setor de Tratamento da Informação - BC/PUCRS (tede2@pucrs.br) on 2016-06-15T18:47:18Z No. of bitstreams: 1 DIS_GISLAINE_VERGINIA_BARONI_COMPLETO.pdf: 4183418 bytes, checksum: 414662f48a1f3c9edb8c4e940e779a3d (MD5)Made available in DSpace on 2016-06-15T18:47:19Z (GMT). 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dc.title.por.fl_str_mv |
Características demográficas, epileptológicas e psiquiátricas associadas à coexistência de epilepsia e crises não epilépticas psicogênicas |
title |
Características demográficas, epileptológicas e psiquiátricas associadas à coexistência de epilepsia e crises não epilépticas psicogênicas |
spellingShingle |
Características demográficas, epileptológicas e psiquiátricas associadas à coexistência de epilepsia e crises não epilépticas psicogênicas Baroni, Gislaine Verginia EPILEPSIA COMORBIDADE TRANSTORNOS MENTAIS NEUROCIÊNCIA MEDICINA CIENCIAS DA SAUDE::MEDICINA |
title_short |
Características demográficas, epileptológicas e psiquiátricas associadas à coexistência de epilepsia e crises não epilépticas psicogênicas |
title_full |
Características demográficas, epileptológicas e psiquiátricas associadas à coexistência de epilepsia e crises não epilépticas psicogênicas |
title_fullStr |
Características demográficas, epileptológicas e psiquiátricas associadas à coexistência de epilepsia e crises não epilépticas psicogênicas |
title_full_unstemmed |
Características demográficas, epileptológicas e psiquiátricas associadas à coexistência de epilepsia e crises não epilépticas psicogênicas |
title_sort |
Características demográficas, epileptológicas e psiquiátricas associadas à coexistência de epilepsia e crises não epilépticas psicogênicas |
author |
Baroni, Gislaine Verginia |
author_facet |
Baroni, Gislaine Verginia |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Palmini, André Luis Fernandes |
dc.contributor.advisor1ID.fl_str_mv |
371.383.160-20 |
dc.contributor.advisor1Lattes.fl_str_mv |
http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4782382H9 |
dc.contributor.authorID.fl_str_mv |
511.068.410-34 |
dc.contributor.authorLattes.fl_str_mv |
http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4771301Y5 |
dc.contributor.author.fl_str_mv |
Baroni, Gislaine Verginia |
contributor_str_mv |
Palmini, André Luis Fernandes |
dc.subject.por.fl_str_mv |
EPILEPSIA COMORBIDADE TRANSTORNOS MENTAIS NEUROCIÊNCIA MEDICINA |
topic |
EPILEPSIA COMORBIDADE TRANSTORNOS MENTAIS NEUROCIÊNCIA MEDICINA CIENCIAS DA SAUDE::MEDICINA |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE::MEDICINA |
description |
Title: Demographic, Epileptological and Psychiatric Features of Co-existing Psychogenic Non-epileptic Seizures and Epilepsy. Introduction: Psychogenic non-epileptic seizures (PNES) comprise the most important differential diagnosis in patients with suspected epileptic seizures (ES), but a clear diagnosis of either one does not preclude at all the other. This co-existence, which has a complex diagnosis and management, is a frequently overlooked co-morbidity, especially in patients with refractory epilepsy. A timely and proper diagnosis of this association reduces risks related to omission of one, improving quality of life and optimizing resources in health care. Objective: To investigate demographic, epidemiologic and psychiatric features suggestive of co-existing ES and PNES that may contribute to precocious suspicion of the association. Material and methods: In this prospective study, all patients older than 16 year admitted to epilepsy surgery program for investigation of seizures with prolonged video-electroencephalogram (V-EEG), from March 2014 to November 2015 were evaluated about demographic, epileptological and psychiatric characteristics. After evaluation, a total of 86 patients received a definitive diagnosis, within the following groups: ES only, PNES only and co-existing ES and PNES. Results: PNES was found in 29% of patients (n=25), with co-existence with ES was revealed in 52 % of these (n=13). Features associated to co-existence was more than one seizure type, temporal lone epilepsy with multifocal or bi-temporal epileptic discharges, and nonspecific white matter hyperintensities on MRI, along with a higher number of psychiatric diagnoses, somatoform disorders, generalized anxiety disorders, and a previous history of psychosis. Also, depression and anxiety levels during evaluation were associated to co-existing PNES and ES. Conclusion: The high prevalence of this co-existence reinforces a need to properly investigate PNES, especially in patients with confirmed ES who become refractory to medical treatment with antiepileptic drugs. The finding of temporal lobe epilepsy with bi-temporal or multifocal spikes associated to this co-existence differs from other studies and deserves to be further evaluated. A thorough anamnesis, focused on semiology of seizures and psychiatric issues contribute to heighten suspicion of the co-existence. Clinical features that suggest a more careful look include multiple seizure types, along with a high number of psychiatric diagnoses in a same patient, especially bipolar affective disorder, post-traumatic stress disorder and a previous history of psychosis, associated to higher levels of anxiety and depression during hospitalization are all highly suggestive of co-existing ES and PNES. This co-existing is common, frequently unsuspected and should not be undermined as a cause of refractory epilepsy and significant suffering for patients and caregivers. |
publishDate |
2016 |
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2016-06-15T18:47:19Z |
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2016-03-03 |
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