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Psychogene nichtepileptische Anfälle

Differenzialdiagnostische Merkmale
  • Philipp S. Reif
  • Laurent M. Willems
  • Adam Strzelczyk
  • Karl Martin Klein
  • Felix Rosenow
Schwerpunkt

Zusammenfassung

Psychogene nichtepileptische Anfälle (PNEA) sind in der Differenzialdiagnostik transienter Bewusstseinsstörungen zu beachten. Ihre Abgrenzung zu Synkopen, epileptischen Anfällen oder vaskulären Erkrankungen ist häufig schwierig und erfordert ein fundiertes Wissen über semiologische Elemente von PNEA und ihrer Differenzialdiagnosen. Fehldiagnosen und sich daraus ableitende Therapiemaßnahmen gehen mit einer erhöhten Morbidität, steigenden Kosten und einer Verschlechterung des Therapieerfolgs für die Patienten einher. Ziel des vorliegenden Artikels ist es, eine Übersicht über PNEA und ihre Abgrenzung zu den wichtigen neurologischen und internistischen Krankheitsbildern Epilepsie und Synkope zu geben.

Schlüsselwörter

Synkope Epilepsie Video-Elektroenzephalographie Semiologie Prognose 

Abkürzungen

GTKA

Generalisierter tonisch-klonischer Anfall

PNEA

Psychogene nichtepileptische Anfälle

PNES

„Psychogenic non epileptic seizures“

Psychogenic non epileptic seizures

Differential diagnostic features

Abstract

Psychogenic nonepileptic seizures (PNES) are to be considered in the differential diagnosis of a transient loss of consciousness. Their discrimination from syncope, epileptic seizures or vascular events can be difficult and requires profound knowledge about the semiology and clinical presentation of PNES and their differential diagnoses. Erroneous diagnoses and the resulting therapies lead to elevated morbidity, elevated costs and a poorer outcome. The aim of the present article is to provide an overview on PNES and their delineation from the clinical pictures of epilepsy and syncope.

Keywords

Syncope Epilepsy Video electroencephalography Semiology Prognosis 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

P.S. Reif erhielt außerhalb der eingereichten Arbeit Drittmittelzuwendungen im Rahmen des LOEWE-Programm des Landes Hessen. L.M. Willems erhielt außerhalb der eingereichten Arbeit Reisekostenunterstützung von der Firma Eisai. A. Strzelczyk erhielt außerhalb der eingereichten Arbeit Honorare von Desitin Arzneimittel, Eisai, LivaNova, Sage Therapeutics, UCB Pharma und Zogenix sowie Drittmittelzuwendungen im Rahmen des LOEWE-Programm des Landes Hessen. K.M. Klein erhielt außerhalb der eingereichten Arbeit Honorare von UCB Pharma, Eisai und Novartis sowie Drittmittelzuwendungen im Rahmen des LOEWE-Programm des Landes Hessen. F. Rosenow erhielt außerhalb der eingereichten Arbeit Zuwendungen von Eisai, UCB, Desitin Arzneimittel, Novartis, Medronic, Cerbomed, ViroPharma, Sandoz, Shire und dem vfa, sowie Drittmittelzuwendungen von der Europäischen Union, der Deutschen Forschungsgemeinschaft, dem LOEWE-Programm des Landes Hessen und von dem Detlev-Wrobel-Fonds für Epilepsie-Forschung.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Alper K, Devinsky O, Perrine K et al (1993) Nonepileptic seizures and childhood sexual and physical abuse. Neurology 43:1950–1953PubMedCrossRefGoogle Scholar
  2. 2.
    American Psychiatric Association (2013) Diagnostic statistical manual of mental disorders: DSM 5. American Psychiatric Association, ArlingtonCrossRefGoogle Scholar
  3. 3.
    An DM, Wu XT, Yan B et al (2010) Clinical features of psychogenic nonepileptic seizures: a study of 64 cases in southwest China. Epilepsy Behav 17:408–411PubMedCrossRefGoogle Scholar
  4. 4.
    Avbersek A, Sisodiya S (2010) Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures? J Neurol Neurosurg Psychiatr 81:719–725CrossRefGoogle Scholar
  5. 5.
    Bayly J, Carino J, Petrovski S et al (2013) Time-frequency mapping of the rhythmic limb movements distinguishes convulsive epileptic from psychogenic nonepileptic seizures. Epilepsia 54:1402–1408PubMedCrossRefGoogle Scholar
  6. 6.
    Benbadis SR, Hauser AW (2000) An estimate of the prevalence of psychogenic non-epileptic seizures. Seizure 9:280–281PubMedCrossRefGoogle Scholar
  7. 7.
    Blumberg J, Fernandez IS, Vendrame M et al (2012) Dacrystic seizures: demographic, semiologic, and etiologic insights from a multicenter study in long-term video-EEG monitoring units. Epilepsia 53:1810–1819PubMedCrossRefGoogle Scholar
  8. 8.
    Bodde NM, Brooks JL, Baker GA et al (2009) Psychogenic non-epileptic seizures–definition, etiology, treatment and prognostic issues: a critical review. Seizure 18:543–553PubMedCrossRefGoogle Scholar
  9. 9.
    Boesebeck F, Freermann S, Kellinghaus C et al (2010) Misdiagnosis of epileptic and non-epileptic seizures in a neurological intensive care unit. Acta Neurol Scand 122:189–195PubMedCrossRefGoogle Scholar
  10. 10.
    Crompton DE, Berkovic SF (2009) The borderland of epilepsy: clinical and molecular features of phenomena that mimic epileptic seizures. Lancet Neurol 8:370–381PubMedCrossRefGoogle Scholar
  11. 11.
    Devinsky O, Gazzola D, Lafrance WC Jr. (2011) Differentiating between nonepileptic and epileptic seizures. Nat Rev Neurol 7:210–220PubMedCrossRefGoogle Scholar
  12. 12.
    Drane DL, Laroche SM, Ganesh GA et al (2016) A standardized diagnostic approach and ongoing feedback improves outcome in psychogenic nonepileptic seizures. Epilepsy Behav 54:34–39PubMedCrossRefGoogle Scholar
  13. 13.
    Dworetzky BA, Weisholtz DS, Perez DL et al (2015) A clinically oriented perspective on psychogenic nonepileptic seizure-related emergencies. Clin Eeg Neurosci 46:26–33PubMedCrossRefGoogle Scholar
  14. 14.
    Gastaut H, Magnus O, Haas AM (1974) Syncopes: generalized anoxic cerebral seizures. Handbook of clinical neurology. North Holland, AmsterdamGoogle Scholar
  15. 15.
    Groppel G, Pataraia E, Olbrich A et al (1999) Clinical symptoms in psychogenic seizures. Wien Klin Wochenschr 111:469–475PubMedGoogle Scholar
  16. 16.
    Groppel G, Kapitany T, Baumgartner C (2000) Cluster analysis of clinical seizure semiology of psychogenic nonepileptic seizures. Epilepsia 41:610–614PubMedCrossRefGoogle Scholar
  17. 17.
    Hendrickson R, Popescu A, Dixit R et al (2014) Panic attack symptoms differentiate patients with epilepsy from those with psychogenic nonepileptic spells (PNES). Epilepsy Behav 37:210–214PubMedCrossRefGoogle Scholar
  18. 18.
    Holtkamp M, Othman J, Buchheim K et al (2006) Diagnosis of psychogenic nonepileptic status epilepticus in the emergency setting. Neurology 66:1727–1729PubMedCrossRefGoogle Scholar
  19. 19.
    Hubsch C, Baumann C, Hingray C et al (2011) Clinical classification of psychogenic non-epileptic seizures based on video-EEG analysis and automatic clustering. J Neurol Neurosurg Psychiatr 82:955–960CrossRefGoogle Scholar
  20. 20.
    Klein KM (2017) Synkopen. Z Epileptol 30:39–44CrossRefGoogle Scholar
  21. 21.
    Lafrance WC Jr., Benbadis SR (2006) Avoiding the costs of unrecognized psychological nonepileptic seizures. Neurology 66:1620–1621PubMedCrossRefGoogle Scholar
  22. 22.
    Lafrance WC Jr., Devinsky O (2004) The treatment of nonepileptic seizures: historical perspectives and future directions. Epilepsia 45(Suppl 2):15–21PubMedCrossRefGoogle Scholar
  23. 23.
    Lafrance WC Jr., Baker GA, Duncan R et al (2013) Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: a staged approach: a report from the International League Against Epilepsy Nonepileptic Seizures Task Force. Epilepsia 54:2005–2018PubMedCrossRefGoogle Scholar
  24. 24.
    Lafrance WC Jr., Baird GL, Barry JJ et al (2014) Multicenter pilot treatment trial for psychogenic nonepileptic seizures: a randomized clinical trial. JAMA Psychiatry 71:997–1005PubMedCrossRefGoogle Scholar
  25. 25.
    Lempert T, Bauer M, Schmidt D (1994) Syncope: a videometric analysis of 56 episodes of transient cerebral hypoxia. Ann Neurol 36:233–237PubMedCrossRefGoogle Scholar
  26. 26.
    Luders H, Acharya J, Baumgartner C et al (1998) Semiological seizure classification. Epilepsia 39:1006–1013PubMedCrossRefGoogle Scholar
  27. 27.
    Martin RC, Gilliam FG, Kilgore M et al (1998) Improved health care resource utilization following video-EEG-confirmed diagnosis of nonepileptic psychogenic seizures. Seizure 7:385–390PubMedCrossRefGoogle Scholar
  28. 28.
    Mayor R, Howlett S, Grunewald R et al (2010) Long-term outcome of brief augmented psychodynamic interpersonal therapy for psychogenic nonepileptic seizures: seizure control and health care utilization. Epilepsia 51:1169–1176PubMedCrossRefGoogle Scholar
  29. 29.
    Mayor R, Brown RJ, Cock H et al (2012) Short-term outcome of psychogenic non-epileptic seizures after communication of the diagnosis. Epilepsy Behav 25:676–681PubMedCrossRefGoogle Scholar
  30. 30.
    Mcgonigal A, Oto M, Russell AJ et al (2002) Outpatient video EEG recording in the diagnosis of non-epileptic seizures: a randomised controlled trial of simple suggestion techniques. J Neurol Neurosurg Psychiatr 72:549–551Google Scholar
  31. 31.
    Opp J, Frank-Job B (2017) Hypothesen zur Genese dissoziativer Anfälle anhand der Anfallsschilderungen. Z Epileptol 30:34–38CrossRefGoogle Scholar
  32. 32.
    Oto M, Conway P, Mcgonigal A et al (2005) Gender differences in psychogenic non-epileptic seizures. Seizure 14:33–39PubMedCrossRefGoogle Scholar
  33. 33.
    De Paola L, Terra VC, Silvado CE et al (2016) Improving first responders’ psychogenic nonepileptic seizures diagnosis accuracy: development and validation of a 6-item bedside diagnostic tool. Epilepsy Behav 54:40–46PubMedCrossRefGoogle Scholar
  34. 34.
    Reuber M, Fernandez G, Bauer J et al (2002) Diagnostic delay in psychogenic nonepileptic seizures. Neurology 58:493–495PubMedCrossRefGoogle Scholar
  35. 35.
    Reuber M, Fernandez G, Bauer J et al (2002) Interictal EEG abnormalities in patients with psychogenic nonepileptic seizures. Epilepsia 43:1013–1020PubMedCrossRefGoogle Scholar
  36. 36.
    Reuber M, Pukrop R, Bauer J et al (2003) Outcome in psychogenic nonepileptic seizures: 1 to 10-year follow-up in 164 patients. Ann Neurol 53:305–311PubMedCrossRefGoogle Scholar
  37. 37.
    Reuber M, Baker GA, Gill R et al (2004) Failure to recognize psychogenic nonepileptic seizures may cause death. Neurology 62:834–835PubMedCrossRefGoogle Scholar
  38. 38.
    Reuber M, Mitchell AJ, Howlett S et al (2005) Measuring outcome in psychogenic nonepileptic seizures: how relevant is seizure remission? Epilepsia 46:1788–1795PubMedCrossRefGoogle Scholar
  39. 39.
    Rosenow F, Bast T, Czech T et al (2016) Revised version of quality guidelines for presurgical epilepsy evaluation and surgical epilepsy therapy issued by the Austrian, German, and Swiss working group on presurgical epilepsy diagnosis and operative epilepsy treatment. Epilepsia 57:1215–1220PubMedCrossRefGoogle Scholar
  40. 40.
    Seneviratne U, Minato E, Paul E (2017) How reliable is ictal duration to differentiate psychogenic nonepileptic seizures from epileptic seizures? Epilepsy Behav 66:127–131PubMedCrossRefGoogle Scholar
  41. 41.
    Sharpe D, Faye C (2006) Non-epileptic seizures and child sexual abuse: a critical review of the literature. Clin Psychol Rev 26:1020–1040PubMedCrossRefGoogle Scholar
  42. 42.
    Vinton A, Carino J, Vogrin S et al (2004) “Convulsive” nonepileptic seizures have a characteristic pattern of rhythmic artifact distinguishing them from convulsive epileptic seizures. Epilepsia 45:1344–1350PubMedCrossRefGoogle Scholar
  43. 43.
    Walczak TS, Bogolioubov A (1996) Weeping during psychogenic nonepileptic seizures. Epilepsia 37:208–210PubMedCrossRefGoogle Scholar
  44. 44.
    Wieling W, Thijs RD, Van Dijk N et al (2009) Symptoms and signs of syncope: a review of the link between physiology and clinical clues. Brain 132:2630–2642PubMedCrossRefGoogle Scholar
  45. 45.
    Wiseman H, Mousa S, Howlett S et al (2016) A multicenter evaluation of a brief manualized psychoeducation intervention for psychogenic nonepileptic seizures delivered by health professionals with limited experience in psychological treatment. Epilepsy Behav 63:50–56PubMedCrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • Philipp S. Reif
    • 1
  • Laurent M. Willems
    • 1
  • Adam Strzelczyk
    • 1
  • Karl Martin Klein
    • 1
  • Felix Rosenow
    • 1
  1. 1.Epilepsiezentrum Frankfurt Rhein-Main, Zentrum der Neurologie und NeurochirurgieUniversitätsklinikum FrankfurtFrankfurt am MainDeutschland

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