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Previous issue date: 2016-03-03 / 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. / T?tulo: Caracter?sticas Demogr?ficas, Epileptol?gicas e Psiqui?tricas Associadas ? Coexist?ncia de Epilepsia e Crises N?o Epil?pticas Psicog?nicas Introdu??o: Crise n?o epil?ptica psicog?nica (CNEP) ? o principal diagn?stico diferencial em pacientes com epilepsia (CE), por?m sua presen?a n?o exclui CE e vice-versa. Essa coexist?ncia, cujo diagn?stico e tratamento s?o complexos, ? uma comorbidade frequente, principalmente em pacientes com epilepsia considerada refrat?ria ao tratamento. A suspei??o e a confirma??o desta coexist?ncia reduzem os riscos envolvidos na omiss?o de qualquer um dos diagn?sticos, reduzindo o impacto na vida pessoal e os custos em sa?de. Objetivo: Investigar caracter?sticas demogr?ficas, epidemiol?gicas e psiqui?tricas sugestivas da coexist?ncia de CE e CNEP que possam contribuir para a suspei??o precoce. Material e m?todos: Foram avaliados prospectivamente, pacientes acima de 16 anos, sequencialmente internados para monitoriza??o atrav?s do v?deo-eletroencefalograma (V-EEG) de longa dura??o no per?odo de mar?o de 2014 a novembro de 2015, quanto ?s caracter?sticas demogr?ficas, epileptol?gicas e psiqui?tricas. Ap?s a conclus?o da investiga??o epileptol?gica, foi poss?vel estabelecer um diagn?stico de certeza em 86 pacientes, divididos em 3 grupos: CE ?nica, CNPE ?nica, coexist?ncia de CE e CNEP. Resultados: CNEP, foi diagnosticada em 29%(n=25) dos pacientes inclu?dos, e a coexist?ncia foi encontrada em 52% destes (n=13). O relato de mais de um tipo de crise obtido atrav?s da anamnese, epilepsia de lobo temporal com descargas bilaterais ou multifocais e altera??es inespec?ficas da subst?ncia branca ? RM, somado ao maior n?mero de diagn?sticos de transtornos psiqui?tricos, incluindo transtorno somatoforme, TAB e hist?ria pr?via de psicose, bem como elevados n?veis de ansiedade e depress?o durante a avalia??o foram caracter?sticas sugestivas da associa??o de CE e CNEP comparado aos outros dois grupos. Conclus?es: A alta preval?ncia da coexist?ncia encontrada refor?a a necessidade de investigar CNEP, principalmente em pacientes com CE confirmada, e naqueles considerados refrat?rios ao tratamento com drogas antiepil?pticas. Os achados eletroencefalogr?ficos de altera??es ictais e interictais temporais ou multifocais bilaterais foram relacionados ? coexist?ncia, e diferem de estudos anteriores. O conjunto da anamnese, focada nos principais aspectos epileptol?gicos, e a avalia??o psiqui?trica, pode contribuir para a suspei??o da coexist?ncia. O relato de diferentes tipos de apresenta??o clinica das crises, somado ao diagn?stico de maior n?mero de comorbidades psiqui?tricas num mesmo individuo, destacando-se transtorno afetivo bipolar, transtorno de estresse p?s-traum?tico e hist?ria pregressa de transtorno psic?tico, associado a n?veis mais elevados de ansiedade e depress?o durante a interna??o s?o sugestivos da associa??o de CE e CNEP.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/6771 |
| Date | 03 March 2016 |
| Creators | Baroni, Gislaine Verginia |
| Contributors | Palmini, Andr? Luis Fernandes |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Medicina e Ci?ncias da Sa?de, PUCRS, Brasil, Faculdade de Medicina |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 7620745074616285884, 600, 600, 600, -8624664729441623247, -969369452308786627 |
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