父母养育方式与儿童自我意识关系的研究

目的　探讨父母养育方式与儿童自我意识之间的相关性。方法　选用Piers Harris儿童自我意识量表(中文版 )和父母养育方式评价量表 (中文版 )对 10 0名儿童进行测查 ,将儿童自我意识量表评分分为低自我意识组( 5 1)、正常范围组及高自我意识组 ( 6 3)进行比较 ,并对父母养育方式与儿童自我意识总分及各因子进行相关分析。结果　低自我意识组的父母情感温暖因子分明显低于另外两组 (P <0 0 5或P <0 0 1) ;父母惩罚严厉因子和拒绝否认因子分明显高于另外两组 (P <0 0 5或P <0 0 1)。父母情感温暖和理解因子、母亲偏爱被试因子与儿童自我意识总分和部分因子均呈显著相关 (P <0 0 5或P <0 0 1) ;父母惩罚严厉因子、拒绝否认因子与自我意识总分和部分因子呈显著负相关 (P <0 0 5或P <0 0 1)。结论　父母养育方式与儿童自我意识水平显著相关     

西藏地区心因性非癫痫性发作的临床特征分析

目的分析西藏地区部分心因性非癫痫性发作(Psychogenic nonepileptic seizures, PNES)患者的临床特征,以助于临床医师对疾病鉴别诊断。方法回顾性分析2016年6月—2018年12月就诊于西藏自治区人民医院神经内科的PNES患者的临床特征,计量资料采用student’s t检验、计数资料采用χ2检验比较组间差异。结果一般临床资料中,视频脑电图监测并记录到的PNES在性别中存在统计学差异(P0.05);患者在平均年龄、平均发作时间、有无家族癫痫史、有无头颅损伤史及婚姻状况等方面无统计学差异(P0.05)。通过对比不同性别患者发作时症状特征发现,其发作时表现在男女性别中无统计学差异(P0.05),但在不同年龄段之间有差异(P0.05)。在发病年龄对比中,该病好发于青年女性,但PNES在各年龄组中发作均无统计学差异。结论西藏地区PNES患者在性别方面有统计学差异,但发作时间、是否结婚、有无癫痫家族史等方面则无。西藏地区PNES患者在不同年龄段内,发作时的临床表现有一定差异。     

心因性非癫痫性发作的鉴别诊断

心因性非癫痫性发作(psychogenic non-epileptic seizure,PNES)也叫假性癫痫,是一种发作性的类似癫痫的行为改变,这种发作不伴有癫痫相关的电生理学如脑电图的改变,也不是由生理原因引起的,而是与心理功能障碍有关,临床表现多变,是与癫痫相鉴别的一个难点.     

儿童心因性非痫性发作研究进展

心因性非痫性发作(psychogenic non-epileptic seizures, PNES)是一种常见的转换障碍疾病,表现为与癫痫发作类似的各种躯体化症状,可伴有紧张、焦虑、恐惧等精神症状,但缺乏相应的神经生物起源及神经电生理改变[1].与既往描述该疾病用的术语"假性发作"、"心因性癫痫"、"癔症性癫痫"等相比...     

不同文化背景父母养育方式与儿童自我意识的调查及相关性分析

目的了解不同文化背景下父母养育方式、儿童自我意识及其相关性。方法分别采用父母养育方式评价量表及Piers—Harris儿童自我意识量表，对四川省凉山州泸姑湖达祖小学高年级学生和四川省绵阳市一城区小学6年级学生进行问卷调查。结果泸沽湖儿童的父母比城市儿童的父母表现出现较小情感温暖、理解，过度保护，过度干涉，拒绝否认，惩罚、严厉及偏爱被试；前者自我感觉智力与学校情况、躯体外貌与属性较好，焦虑程度较低，其过度保护、过度干涉与儿童的智力与学校情况呈正相关，和幸福与满足呈负相关；拒绝否认、惩罚严厉与儿童的焦虑呈正相关，和幸福与满足以及总分呈负相关。结论不同文化背景的父母对儿童的养育方式有较大差异，并对儿童自我意识的一些纬度也有一定影响。     

心因性非癫痫发作患者的临床特征及预后分析

目的 探讨心因性非癫痫发作(PNES)的临床特征、预后及影响预后的相关因素.方法 回顾性分析2011年1月-2019年12月于四川大学华西医院的152例行视频脑电图(VEEG)诊断为PNES患者,并分析影响预后的相关因素.结果 患者主要症状为闭眼、身体僵硬、四肢抽搐、四肢颤抖和肢体非同相运动,42人(27.6％)脑电图...     

心因性非痫性发作误诊临床探讨

目的 通过分析心因性非痫性发作与癫痫性发作患者的发作诱因、临床表现,脑电图、颅脑MRI等相关指标的差异,以减少误诊.方法 采用回顾性分析法对18例确诊为心因性非痫性发作患者的临床资料进行分析,并与随机抽取的50例癫痫患者的临床资料进行比较.结果 18例患者发作的诱因多与环境刺激及情绪变化有关;发作频繁,清醒期发作;发作期EEG较相似,表现为在大量的肌电伪迹、动作伪迹间可见正常枕区背景节律,或表现为全部正常节律,无癫痫样放电.MRI未见与发作相关颅脑改变;心理疏导联合相关药物可减轻发作.与癫痫在以上方面表现均有明显差异.结论 心因性非痫性的发作是由多种心理因素相互作用所致,临床医师应根据病史、临床表现、发作期脑电图特点、药物反应等综合分析进行确诊,避免误诊.     

35例儿童心因性发作的临床分析

心因性发作又称假性癫痫发作,是一组临床症状复杂多样的非真性癫 发作,临床常易误诊,本文通过临床诊治的３５例心因性发作的患儿的临床表现,实验室检查以及误诊情况对本症的诊断和治疗作一探讨。     

心因性非痫性发作患者的抑郁、焦虑症状及人格特质研究

目的 分析心因性非痫性发作（PNES）患者的抑郁、焦虑症状及人格特质。方法 选取 2020 年 1 月至 2021 年 3 月在首都医科大学宣武医院神经内科治疗的 22 例 PNES 患者（PNES 组）及 40 例 癫痫患者（癫痫组）的一般人口学及相关临床资料,使用 24 项汉密尔顿抑郁量表（HAMD-24）、汉密尔顿 焦虑量表（HAMA）及明尼苏达多项人格测验（MMPI）评估患者的抑郁、焦虑状态及人格特质。比较两组 患者一般人口学特征、临床资料、抑郁、焦虑状态及人格特质的差异。结果 PNES 组本次发作有诱发 因素者占比、发作频率高于癫痫组,差异有统计学意义（P＜ 0.05）;HAMA 总分［11.80（7.00,15.50）分比 8.50（5.00,14.00）分］、躯体性焦虑因子评分［5.30（2.00,9.50）分比 3.10（1.00,4.75）分］、HAMD-24 总分 ［10.60（5.50,14.50）分比7.30（5.00,8.50）分］、焦虑/躯体化症状因子评分［4.00（2.50,5.00）分比2.80（2.00, 4.00）分］、睡眠障碍因子评分［1.80（0,3.00）分比 1.00（0,2.00）分］、绝望感因子评分［1.10（0,2.00）分 比 0.40（0,1.50）分］高于癫痫组,差异有统计学意义（Z=2.13、1.98、1.97、2.64、2.15、2.76;P＜ 0.05）; PNES 组 MMPI 中的疑病［（67.36±2.02）分比（56.79±1.21）分］、抑郁［（64.09±2.10）分比（52.07±1.97）分］、 癔病［（67.00±1.79）分比（54.62±1.17）分］、精神衰弱的标准分［（65.55±2.15）分比（58.40±1.82）分］高 于癫痫组,神经质［（71.32±2.05）分比（56.88±1.12）分］和掩饰性因子评分［（45.09±2.38）分比（38.57± 0.98）分］高于癫痫组（t=4.77、4.15、6.00、2.41、6.74、2.53;P＜ 0.05）,非社会性因子评分低于癫痫组 ［（44.91±2.03）分比（53.24±1.63）分］,差异有统计学意义（t=-3.10,P＜ 0.01）。结论 PNES 相对癫痫患 者的抑郁、焦虑症状明显,具有神经质、掩饰性的人格特质,而癫痫患者的非社会化倾向更加明显。     

儿童非癫痫性发作

目的：探讨儿童非癫痫性发作的各种临床表现形式。方法：对３５例非癫痫性发作患儿的临床结合脑电图监测进行分析。结果：３５例儿童非癫痫发作中,生理性发作占５１％,且平均年龄最小,全部患儿经２４小时脑电图或录相监测脑电图检查发作间期和／或发作期均无异常放电;本组误诊２１例,其中阗痫１０例。结论：儿童的非癫痫性发作表现形式多样,以生理性发作最多。儿童非癫痫性发作易误诊为癫痫及其它疾病,应用动态脑电图监测对其     

Ictal injury in psychogenic non-epileptic seizures

PurposeWhilst ictal injuries in psychogenic non-epileptic seizures (PNES) have been reported previously, very few studies have described the spectrum of ictal injuries in these patients. In the current study, we tried to determine the spectrum of reported ictal injuries associated with PNES and to investigate the possible associated risk factors.MethodsAll patients with PNES were recruited prospectively in the outpatient epilepsy clinic at Shiraz University of Medical Sciences, between 2008 and 2013. The diagnosis was made by clinical assessment and ictal video-EEG recordings. We asked all patients and their caregivers about history of any minor (e.g., tongue biting, bruises, and lacerations) or major (e.g., burns and fractures) physical injuries associated with their seizures, since their disease started. Clinical variables, factors potentially predisposing to PNES and video-EEG recordings of all patients were analyzed.ResultsTwo hundred and eleven patients were studied. Sixty-five patients (30.8%) reported injuries with one or more of their attacks. The most common type of reported injury was tongue biting. Lacerations, bruises, limb fractures, dental injury, and burn were also reported.ConclusionPNES commonly produce physical injuries. Despite the shibboleth that injuries rarely occur during PNES, mild injuries commonly happen and even severe injuries such as fractures and burns are not uncommonly reported in these patients. Patients with more dramatic seizure manifestations (e.g., urinary incontinence) were more likely to report ictal injuries.     

Juvenile and adult-onset psychogenic non-epileptic seizures

Purpose

Psychogenic non-epileptic seizures (PNES) tend to begin in adolescence and young adulthood, although the seizures can occur in a wide range of ages. In the current study, we investigated the age of onset in patients with PNES and tried to determine the correlation between the age of onset and the demographic and clinical characteristics and factors potentially predisposing to PNES.

Methods

In this cross-sectional study, all patients with a clinical diagnosis of PNES were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences from 2008 to 2012. We dichotomized the patients into two groups; those with age of onset below 18 years (juvenile), and those with age of onset at 18–55 years (adult-onset). We studied the demographic and clinical characteristics and factors potentially predisposing to PNES between these two groups. Statistical analyses were performed using Chi square and Fisher's Exact tests and Mann–Whitney U test.

Results

Fifty-seven patients with juvenile and 129 people with adult-onset PNES were studied. Demographic characteristics of these two groups were not different significantly. Seizure characteristics and semiology in these two groups were not significantly different either. However, factors potentially predisposing to PNES were significantly different between these two groups. History of being abused, academic failure, epilepsy or family history of epilepsy were more frequently observed in juvenile PNES, while medical comorbidities were more frequent among patients with adult-onset PNES.

Conclusion

Age of onset of PNES is not correlated with the clinical manifestations; however, factors potentially predisposing to PNES are significantly different in patients with juvenile compared to those with adult-onset PNES.     

Clinical profile of psychogenic non-epileptic seizures in adults: A study of 63 cases

Aims:

To evaluate clinical profile and short-term outcome of psychogenic non-epileptic seizures (PNES) in Indian adult population.

Setting and Design:

A prospective observational study, conducted at tertiary teaching institute at New Delhi.

Materials and Methods:

Sixty-three patients with confirmed PNES were enrolled. The diagnosis was based on witnessing the event during video-electroencephalography (Video-EEG) monitoring. A detailed clinical evaluation was done including evaluation for coexistent anxiety or depressive disorders. Patients were divided into two groups on the basis of excessive or paucity of movements during PNES attacks. Patients were followed-up to 12 months for their PNES frequency.

Statistical Analysis:

Means and standard deviations were calculated for continuous variables. Chi-square and Students t-test were used to compare categorical and continuous variables respectively.

Results:

The mean age at onset of PNES was 25.44 years; with F:M ratio of 9.5:1. Coexistent epilepsy was present in 13 (20.63%) cases. Twenty-two patients (44%) with only PNES (n = 50) had received antiepileptic drugs. Out of 63 patients of PNES 24 (38.1%) had predominant motor phenomenon, whereas 39 (61.9%) had limp attacks. The common features observed were pre-ictal headache, ictal eye closure, jaw clenching, resistant behavior, ictal weeping, ictal vocalization, and unresponsiveness during episodes. Comorbid anxiety and depressive disorders was seen in 62.3% and 90.16% patients, respectively. Short-term (6-12 months) outcome of 45 patients was good (seizure freedom in 46.66% and >50% improvement in 24.44% cases).

Conclusion:

PNES is common, but frequently misdiagnosed and treated as epileptic seizures. A high index of suspicion is required for an early diagnosis. Proper disclosure of diagnosis and management of the psychiatric comorbidities can improve their outcome.

Limitation:

Limited sample size and change in seizures frequency as the only parameter for the assessment of the outcome are the two major limitations of our study.     

Clinical features of psychogenic non-epileptic seizures in prepubertal and pubertal patients with idiopathic epilepsy

A retrospective multicentre study was performed to analyse psychogenic non-epileptic seizures (PNES) in prepubertal and pubertal patients with idiopathic epilepsy and to determine whether have different clinical characteristics. In this study, we reviewed 36 patients from six neurological referral centres: Department of Pediatrics, Chieti (3 patients); Department of Child Neuropsychiatry, Naples (9 patients); Department of Child Neuropsychiatry, Bologna (8 patients); Department of Neuroscience, Tor Vergata University, Rome (3 patients); Department of Pediatrics, La Sapienza University, Rome (5 patients); and Department of Pediatrics, Siena (8 patients). The population was divided according to Tanner’stages into 14 prepubertal (group I) and 22 pubertal (group II) patients. The two groups were compared on several variables examining the differences between them. The most frequent clinical manifestations in group I were unresponsive events, whereas in group II, motor events were exhibited more significantly. Mood disorders, including major depression, appeared more frequently in pubertal group, but this did not reach a significant difference. Among the psychosocial stressors, fear of rejection and need for attention were the predominant types in the prepubertal patients. The findings of this study reveal some similarities and differences between prepubertal and pubertal patients, which might help to identify predictive factors in patients affected by idiopathic epilepsy who can develop PNES.     

The spectrum of psychogenic non-epileptic seizures and comorbidities seen in an epilepsy monitoring unit

We sought to study characteristics of patients presenting with psychogenic non-epileptic seizures (PNES), with and without major psychiatric comorbidity. A total of 39 patients who were diagnosed with PNES in a tertiary care setting were studied, and those patients with and without axis I psychiatric disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) were compared. The mean time in confirming the diagnosis was 9 years. More than half the patients were taking anti-epileptic medications when they presented for video-electroencephalographic monitoring. The mean monitoring time required to capture a PNES was 0.6 days. Comorbid chronic medical conditions were found in 38.5% and axis I-psychiatric diagnoses in 48.7%. There were no significant differences in characteristics between those with and without major psychiatric comorbidities.     

Clinical events in psychogenic non-epileptic seizures based on semiological seizure classification

Abstract

Objectives:

None of the classifications of psychogenic non-epileptic seizures (PNES) have been widely accepted and used by physicians so far. In this study we aimed at classifying PNES on the basis of a modified version of semiological seizure classification (SSC). We also sought to assess the interrater reliability (IRR) of the PNES diagnosis based on SSC.

Methods:

We classified PNES into four types on the basis of our modification of SSC: pseudoaura, dialeptic, motor, and special (atonic, astatic, hypotonic) spells. Pseudoauras were not included in the statistical analysis. Ninety-one PNES attacks were observed during the 55 video-EEG sessions recorded for all patients. The interrater agreement was assessed by the kappa coefficient.

Results:

Twenty-nine women (78·3%) and eight men (21·6%) were surveyed, with a mean age of 28·4 ± 9·6 (range 16–54). The final diagnosis of PNES was established after a mean of 4·5 ± 2·3 years following the onset of PNES attacks in the patients. The mean seizure duration in the PNES was 241 seconds and 40·5% of our patients had PNES longer than 300 seconds. Motor and special PNES were the most common types observed by all the raters. The kappa values for each pair were as follows: Observers I–II 0·51 (p = 0·000), Observers I–III 0·47 (p = 0·000), and Observers II–III 0·73 (p = 0·000).

Conclusions:

Interobserver agreement was moderate and substantial for three observers who classified PNES according to our modified SSC. The modified version of SSC could be used without difficulty in classifying PNES. Using SSC for PNES both shortens the period before diagnosis and eliminates the need to learn another new and acceptable classification for PNES.     

Patients with epilepsy and patients with psychogenic non-epileptic seizures: Video-EEG, clinical and neuropsychological evaluation

Purpose

The incidence of psychogenic non-epileptic seizures (PNES) is 4.9/100,000/year and it is estimated that about 20–30% of patients referred to tertiary care epilepsy centers for refractory seizures have both epilepsy and PNES.The purpose of our study is to evaluate psychiatric disorders and neuropsychological functions among patients with PNES, patients with epilepsy associated with PNES and patients with epilepsy.

Methods

We evaluated 66 consecutive in-patients with video-EEG recordings: 21 patients with epilepsy, 22 patients with PNES and 10 patients with epilepsy associated with PNES; 13 patients were excluded (8 because of mental retardation and 5 because they did not present seizures or PNES during the recording period).

Results

All patients with PNES had a psychiatric diagnosis (100%) vs. 52% of patients with epilepsy. Cluster B personality disorders were more common in patients with PNES.We observed fewer mood and anxiety disorders in patients with PNES compared with those with epilepsy.We did not find statistically significant differences in neuropsychological profiles among the 3 patient groups.

Conclusion

This study can help to contribute to a better understanding of the impact of PNES manifestations, in addition to the occurrence of seizures, in order to provide patients with more appropriate clinical, psychological and social care.     

Children with psychogenic non-epileptic seizures (PNES): A detailed semiologic analysis and modified new classification

Purpose: To analyze children with psychogenic non epileptic seizures and propose a modified new classification. Methods: This retrospective analysis included 56 children aged <18 years (M:F = 26:30; mean age: 12.3 ± 4.0 years) diagnosed PNES on video-EEG monitoring. The semiological characteristics like pattern of bodily movements, emotional signs, stereotypy, ictal vocalization, responsiveness, delay in diagnosis etc. were recorded. We analyzed our data as per previous adult classifications and proposed a modified classification. Results: There were 190 recorded attacks (range: 1–9, median: 3) recorded. The age at onset of PNES was 8.9 ± 4.1 years (range: 0.4–15.8 years; median: 9 years), age at diagnosis: 11.9 ± 4.1 years (range: 2–17; median: 12.0 years), delay in diagnosis: 3.2 ± 3.7 years (range: 0–15; median: 2.0 years). Anxiety disorder was seen in 9 (16.1%), stress in 6 (10.7%) children. Flexion/extension bodily movements were seen in 40 (70.1%), negative emotional signs in 17 (30.4%) and tremors in 14 (25%) cases. Thirty-three (58.9%) patients diagnosed as having true seizures initially and were on anti-epileptic drugs (AEDs), 14 patients (25.0%) initially diagnosed of PNES which remained unchanged after VEEG, nine patients (16.1%) had both PNES and true seizures. Twenty-six (46.4%) of our patients into the existing classifications. We then classified our patients into categories of a modified new classification: Hypermotor: 13 (23.2%), partial motor: 8 (14.3%), affective/emotional behaviour phenomena: 2 (3.6%), dialeptic: 8 (14.3%), ‘aura’: 3 (5.4%), mixed: 22 (39.3%). Conclusion: Incorrect diagnosis of epilepsy leads to unnecessary drug treatment. A detailed analysis of semiology and classification helps in early diagnosis of PNES. A modified systematic classification of PNES is proposed which would help in better standardization of PNES.