Management of psychogenic non-epileptic seizures: a multidisciplinary approach

被引：61

作者：

Gasparini, S. ^{[1
,2
]}

Beghi, E. ^{[3
]}

Ferlazzo, E. ^{[1
,2
,4
]}

Beghi, M. ^{[5
]}

Belcastro, V. ^{[6
]}

Biermann, K. P. ^{[7
]}

Bottini, G. ^{[8
]}

Capovilla, G. ^{[9
]}

Cervellione, R. A. ^{[10
]}

Cianci, V. ^{[2
]}

Coppola, G. ^{[11
]}

Cornaggia, C. M. ^{[12
]}

De Fazio, P. ^{[13
]}

De Masi, S. ^{[7
]}

De Sarro, G. ^{[14
]}

Elia, M. ^{[15
]}

Erba, G. ^{[16
]}

Fusco, L. ^{[17
]}

Gambardella, A. ^{[1
,4
]}

Gentile, V. ^{[18
]}

Giallonardo, A. T. ^{[19
]}

Guerrini, R. ^{[20
,21
]}

Ingravallo, F. ^{[22
]}

Iudice, A. ^{[23
]}

Labate, A. ^{[1
,4
]}

Lucenteforte, E. ^{[21
]}

Magaudda, A. ^{[24
]}

Mumoli, L. ^{[1
]}

Papagno, C. ^{[25
,26
,27
]}

Pesce, G. B. ^{[18
]}

Pucci, E. ^{[28
]}

Ricci, P. ^{[29
]}

Romeo, A. ^{[30
,31
]}

Quintas, R. ^{[32
]}

Sueri, C. ^{[2
]}

Vitaliti, G. ^{[33
]}

Zoia, R. ^{[34
]}

Aguglia, U. ^{[1
,2
,4
,35
]}

机构：

[1] Magna Greacia Univ Catanzaro, Dept Med & Surg Sci, Catanzaro, Italy

[2] Great Metropolitan Hosp Reggio Calabria, Reg Epilepsy Ctr, Reggio Di Calabria, Italy

[3] Ist Ric Farmacol Mario Negri IRCCS, Dept Neurosci, Milan, Italy

[4] CNR, Inst Mol Bioimaging & Physiol, Catanzaro, Italy

[5] AUSL Romagna, Dept Mental Hlth, Ravenna, Italy

[6] St Anna Hosp, Dept Med, Neurol Unit, Como, Italy

[7] Meyer Childrens Hosp, Clin Trial Off, Florence, Italy

[8] Univ Pavia, Dept Brain & Behav Sci, Pavia, Italy

[9] Azienda Osped Carlo Poma, Child Neuropsychiat Unit, Mantua, Italy

[10] Italian Federat Epilepsies, Milan, Italy

[11] Univ Salerno, Child Neuropsychiat Unit, Dept Med Surg & Dent, Salerno, Italy

[12] Univ Milano Bicocca, Sch Med & Surg, Milan, Italy

[13] Magna Graecia Univ Catanzaro, Dept Hlth Sci, Psychiat Unit, Catanzaro, Italy

[14] Magna Graecia Univ Catanzaro, Dept Hlth Sci, Pharmacol Unit, Catanzaro, Italy

[15] Oasi Res Inst IRCCS, Unit Neurol & Clin Neurophysiopathol, Troina, EN, Italy

[16] Univ Rochester, SEC, Dept Neurol, Rochester, NY USA

[17] Bambino Gesu Pediat Hosp, Dept Neurosci, Neurophysiol Unit, Rome, Italy

[18] Italian Assoc Epilepsies, Bologna, Italy

[19] Sapienza Univ, Dept Neurosci, Neurol Unit, Rome, Italy

[20] Italian Soc Neurol & Psychiat Infancy & Adolescen, Florence, Italy

[21] Univ Florence, Dept Neurosci Psychol Drug Res & Child Hlth, Florence, Italy

[22] Univ Bologna, Dept Med & Surg Sci DIMEC, Bologna, Italy

[23] Univ Pisa, Div Neurol, Pisa, Italy

[24] Univ Messina, Epilepsy Ctr, Messina, Italy

[25] Univ Trento, CIMeC, Trento, Italy

[26] Univ Trento, CeRiN, Trento, Italy

[27] Univ Milano Bicocca, Dept Psychol, Milan, Italy

[28] ASUR Marche AV3, Neurol Unit, Macerata, Italy

[29] Magna Graecia Univ Catanzaro, Catanzaro, Italy

[30] Fatebenefratelli & Oftalmico Hosp, Pediat Neurol Unit, Milan, Italy

[31] Fatebenefratelli & Oftalmico Hosp, Epilepsy Ctr, Milan, Italy

[32] IRCCS Fdn, Neurol Inst Carlo Besta, Clin & Expt Epileptol Unit, Milan, Italy

[33] Univ Hosp Policlin Vittorio Emanuele, Catania, Italy

[34] Univ Milan, Sect Legal Med, Dept Hlth & Biomed Sci, Milan, Italy

[35] Italian Neurol Soc, Epilepsy Study Grp, Catanzaro, Italy

来源：

EUROPEAN JOURNAL OF NEUROLOGY | 2019年 / 26卷 / 02期

关键词：

conversion disorder; EEG; epilepsy; POSTTRAUMATIC-STRESS-DISORDER; RANDOMIZED CONTROLLED-TRIAL; CAPILLARY PROLACTIN MEASUREMENT; SERUM PROLACTIN; HEART-RATE; PSYCHOLOGICAL TREATMENT; CREATINE-KINASE; ABUSE HISTORY; RISK-FACTORS; DIAGNOSIS;

D O I：

10.1111/ene.13818

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

The International League against Epilepsy (ILAE) proposed a diagnostic scheme for psychogenic non-epileptic seizure (PNES). The debate on ethical aspects of the diagnostic procedures is ongoing, the treatment is not standardized and management might differ according to age group. The objective was to reach an expert and stakeholder consensus on PNES management. A board comprising adult and child neurologists, neuropsychologists, psychiatrists, pharmacologists, experts in forensic medicine and bioethics as well as patients' representatives was formed. The board chose five main topics regarding PNES: diagnosis; ethical issues; psychiatric comorbidities; psychological treatment; and pharmacological treatment. After a systematic review of the literature, the board met in a consensus conference in Catanzaro (Italy). Further consultations using a model of Delphi panel were held. The global level of evidence for all topics was low. Even though most questions were formulated separately for children/adolescents and adults, no major age-related differences emerged. The board established that the approach to PNES diagnosis should comply with ILAE recommendations. Seizure induction was considered ethical, preferring the least invasive techniques. The board recommended looking carefully for mood disturbances, personality disorders and psychic trauma in persons with PNES and considering cognitive-behavioural therapy as a first-line psychological approach and pharmacological treatment to manage comorbid conditions, namely anxiety and depression. Psychogenic non-epileptic seizure management should be multidisciplinary. High-quality long-term studies are needed to standardize PNES management.

引用

页码：205 / +

页数：13

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