心因性非癫痫性发作患者和癫痫患者心理治疗期间发作的频率及管理_Journal of Epilepsy

Authors：

 StevenKemp , Christopher D.Graham , RebeccaChan , 袁振宇　田淼晶　译 , 薛国芳　审

Corresponding author：

StevenKemp, Email: stevenkemp@nhs.net

Keywords：

鉴别诊断; 治疗期发作; 患者安全; 心因性非痫性发作

DOI：

10.7507/2096-0247.20190052

Video：

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越来越多的证据表明，心理治疗可有效改善癫痫和心因性非痫性发作（Psychogenic nonepileptic seizures，PNES）的预后。然而，治疗期间发作的风险可能引发对治疗安全性和发作导致治疗中断的担忧。研究探讨癫痫和 PNES 患者的发作风险、心理治疗期间发作的时间以及心理治疗师应对发作的措施。研究纳入了连续在英国两个神经病学中心接受心理治疗的癫痫和 PNES 患者。采用一个包含 12 项信息的调研表格收集患者在门诊心理治疗期间发作的信息。研究共评估了 97 例癫痫患者和 195 例 PNES 患者。1/32 的癫痫患者和 1/8 的 PNES 患者在治疗期间至少有 1 次发作。癫痫患者出现发作的疗程占总疗程的 1/136，PNES 患者出现发作的疗程占总疗程的 1/36。PNES 患者治疗期间发作的风险显著高于癫痫患者［（OR=4.4，95%CI（1.3，15.2）］。发作往往发生于整个治疗的前半部分和个别治疗期，且仅短暂中断治疗。仅有 1 例 PNES 患者需住院观察，但无需留院过夜。心理治疗期间确实会出现发作，且 PNES 患者比癫痫患者更为常见。发作较少对心理治疗造成重大干扰，治疗师多可在没有额外医务人员帮助的情况下进行治疗。尽管如此，该研究表明心理治疗师应预测治疗期间发作的风险并制定安全的管理计划。PNES 患者在治疗期间发作频率较高，有助于我们理解其诱导发作的机制。

Citation： StevenKemp, Christopher D.Graham, RebeccaChan, 袁振宇　田淼晶　译, 薛国芳　审. 心因性非癫痫性发作患者和癫痫患者心理治疗期间发作的频率及管理. Journal of Epilepsy, 2019, 5(4): 312-319. doi: 10.7507/2096-0247.20190052 Copy

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2.	Edwards MJ, Adams RA, Brown H, et al. A Bayesian account of ‘hysteria’. Brain, 2012, 135(Pt 11): 3495-3512.
3.	Kwan P, Arzimanoglou A, Berg AT, et al. Definition of drug resistant epilepsy: consensus proposal by thead hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia, 2010, 51(6): 1069-1077.
4.	Reuber M, Pukrop R, Bauer J, et al. Outcome in psychogenic nonepileptic seizures: 1 to 10-year follow-up in 164 patients. Ann Neurol, 2003, 53(3): 305-311.
5.	Brown RJ, Reuber M. Psychological and psychiatric aspects of psychogenic non-epileptic seizures (PNES): a systematic review. Clin Psychol Rev, 2016, 45: 157-182.
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14.	LaFrance WC, Reuber M, Goldstein LH. Management of psychogenic nonepileptic seizures. Epilepsia, 2013, 54(Suppl 1): 53-67.
15.	Kanemoto K, LaFrance WC, Duncan R, et al. PNES around the world: where we are now and how we can close the diagnosis and treatment gaps. An ILAE PNES Task Force report. Epilepsia Open, 2017, 2(3): 307-316.
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17.	Mayor R, Smith PE, Reuber M. Management of patients with nonepileptic attack disorder in the United Kingdom: a survey of health care professionals. Epilepsy Behav, 2011, 21(4): 402-406.
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19.	Butler AC, Chapman JE, Forman EM, et al. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev, 2006, 26(1): 17-31.
20.	Hayes SC, Luoma JB, Bond FW, et al. Acceptance and commitment therapy: Model, processes and outcomes. Behav Res Ther, 2006, 44(1): 1-25.
21.	Graham CD, Gouick J, Krahe C, et al. A systematic review ofthe use of Acceptance and Commitment Therapy (ACT) inchronic disease and long-term conditions. Clin Psychol Rev, 2016, 30: 46-58.
22.	Dewhurst E, Novakova B, Reuber M. A prospective service evaluation of acceptance and commitment therapy for patients with refractory epilepsy. Epilepsy Behav, 2015, 46: 234-241.
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24.	Ogden P, Pain C, Fisher J. A sensorimotor approach to the treatment of trauma and dissociation. Psychiatric Clin, 2006, 29(1): 263-279.
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26.	Howlett S, Reuber M. An augmented model of brief psychodynamic interpersonal therapy for patients with nonepileptic seizures. Psychotherapy (Chic), 2009, 46(1): 125-138.
27.	Brown RJ, Reuber M. Towards an integrative theory of psychogenic non-epileptic seizures (PNES). ClinPsychol Rev, 2016, 47: 55-70.
28.	Reuber M, Brown RJ. Understanding psychogenic nonepilepticseizures-Phenomenology, semiologyand the integrative cognitive model. Seizure, 2017, 44: 199-205.
29.	Myers L, Vaidya-Mathur U, Lancman M. Prolonged exposuretherapy for the treatment of patientsdiagnosed with psychogenicnon-epileptic seizures (PNES) and post-traumatic stress disorder(PTSD). Epilepsy Behav, 2017, 31: 86-92.
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31.	Nguyen R, Zenteno JF. Injuries in epilepsy: a review of its prevalence, risk factors, type of injuries andprevention. Neurol Int, 2009, 1(1): e20.
32.	Peguero E, Abou-Khalil B, Fakhoury T, et al. Self-injury and incontinence in psychogenic seizures. Epilepsia, 1995, 36(6): 586-591.
33.	Worsely C, Whitehead K, Kandler R, et al. Illness perceptions of health care workers in relation to epileptic and psychogenic nonepileptic seizures. Epilepsy Behav, 2011, 20(4): 668-673.

1. Wiseman H, Reuber M. New insights into psychogenic nonepileptic seizures 2011-2014. Seizure, 2015, 29: 69-80.
2. Edwards MJ, Adams RA, Brown H, et al. A Bayesian account of ‘hysteria’. Brain, 2012, 135(Pt 11): 3495-3512.
3. Kwan P, Arzimanoglou A, Berg AT, et al. Definition of drug resistant epilepsy: consensus proposal by thead hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia, 2010, 51(6): 1069-1077.
4. Reuber M, Pukrop R, Bauer J, et al. Outcome in psychogenic nonepileptic seizures: 1 to 10-year follow-up in 164 patients. Ann Neurol, 2003, 53(3): 305-311.
5. Brown RJ, Reuber M. Psychological and psychiatric aspects of psychogenic non-epileptic seizures (PNES): a systematic review. Clin Psychol Rev, 2016, 45: 157-182.
6. Mula M. Cognitive dysfunction in patients with epilepsy: focus on clinical variables. Fut Neurol, 2015, 10: 41-48.
7. Reuber M. Are psychogenic non-epileptic seizures an expression of " neurologic” pathology?”. London: Academic Press, 2008: 153-177.
8. Tellez-Zenteno JF, Patten SB, Jette N, et al. Psychiatric comorbidity in epilepsy: a population-based analysis. Epilepsia, 2007, 48(12): 2336-2344.
9. Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia, 2014, 55(4): 475-482.
10. Jacoby A, Snape D, Baker GA. Determinants of quality of life in people with epilepsy. Neurol Clin, 2009, 27(4): 843-863.
11. Jones B, Reuber M, Norman P. Correlates of health-related quality of life in adults with psychogenic nonepileptic seizures: A systematic review. Epilepsia, 2016, 57(2): 171-181.
12. Michaelis R, Tang V, Wagner JL, et al. Psychological treatment for people with epilepsy. The Cochrane data base of systematicreviews, 2017, 10: CD012081.
13. Carlson P, Perry KN. Psychological interventions for psychogenic non-epileptic seizures: A meta-analysis. Seizure, 2017, 45: 142-150.
14. LaFrance WC, Reuber M, Goldstein LH. Management of psychogenic nonepileptic seizures. Epilepsia, 2013, 54(Suppl 1): 53-67.
15. Kanemoto K, LaFrance WC, Duncan R, et al. PNES around the world: where we are now and how we can close the diagnosis and treatment gaps. An ILAE PNES Task Force report. Epilepsia Open, 2017, 2(3): 307-316.
16. LaFrance WC, Rusch MD, Machan JT. What is " treatment asusual” for nonepileptic seizures?. Epilepsy Behav, 2008, 12(3): 388-394.
17. Mayor R, Smith PE, Reuber M. Management of patients with nonepileptic attack disorder in the United Kingdom: a survey of health care professionals. Epilepsy Behav, 2011, 21(4): 402-406.
18. LaFrance WCJr, Wincze JP. Treating nonepileptic seizures: therapist guide. Oxford, UK: Oxford University Press, 2015.
19. Butler AC, Chapman JE, Forman EM, et al. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev, 2006, 26(1): 17-31.
20. Hayes SC, Luoma JB, Bond FW, et al. Acceptance and commitment therapy: Model, processes and outcomes. Behav Res Ther, 2006, 44(1): 1-25.
21. Graham CD, Gouick J, Krahe C, et al. A systematic review ofthe use of Acceptance and Commitment Therapy (ACT) inchronic disease and long-term conditions. Clin Psychol Rev, 2016, 30: 46-58.
22. Dewhurst E, Novakova B, Reuber M. A prospective service evaluation of acceptance and commitment therapy for patients with refractory epilepsy. Epilepsy Behav, 2015, 46: 234-241.
23. Hobson RF. Forms of feeling: the heart of psychotherapy. London, UK: Tavistock, 1985.
24. Ogden P, Pain C, Fisher J. A sensorimotor approach to the treatment of trauma and dissociation. Psychiatric Clin, 2006, 29(1): 263-279.
25. Rothschild B. Trauma essentials: the go-to guide (go-to guides for mental health). New York, NY: WW Norton & Company, 2011.
26. Howlett S, Reuber M. An augmented model of brief psychodynamic interpersonal therapy for patients with nonepileptic seizures. Psychotherapy (Chic), 2009, 46(1): 125-138.
27. Brown RJ, Reuber M. Towards an integrative theory of psychogenic non-epileptic seizures (PNES). ClinPsychol Rev, 2016, 47: 55-70.
28. Reuber M, Brown RJ. Understanding psychogenic nonepilepticseizures-Phenomenology, semiologyand the integrative cognitive model. Seizure, 2017, 44: 199-205.
29. Myers L, Vaidya-Mathur U, Lancman M. Prolonged exposuretherapy for the treatment of patientsdiagnosed with psychogenicnon-epileptic seizures (PNES) and post-traumatic stress disorder(PTSD). Epilepsy Behav, 2017, 31: 86-92.
30. Asadi-Pooya AA, Emami M, Emami Y. Ictal injury in psychogenic non-epileptic seizures. Seizure, 2014, 23(5): 363-366.
31. Nguyen R, Zenteno JF. Injuries in epilepsy: a review of its prevalence, risk factors, type of injuries andprevention. Neurol Int, 2009, 1(1): e20.
32. Peguero E, Abou-Khalil B, Fakhoury T, et al. Self-injury and incontinence in psychogenic seizures. Epilepsia, 1995, 36(6): 586-591.
33. Worsely C, Whitehead K, Kandler R, et al. Illness perceptions of health care workers in relation to epileptic and psychogenic nonepileptic seizures. Epilepsy Behav, 2011, 20(4): 668-673.

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