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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(11): 957-962
DOI: 10.1590/0004-282X-ANP-2020-0546
Article

The evaluation of psychogenic non-epileptic seizures (PNES) cases with saline injection method in video-EEG monitorization unit

Avaliação de casos de crises não epilépticas psicogênicas (CNEPs) pelo método de injeção de solução salina em unidade de monitoramento por vídeo-EEG
İbrahim Bora 
1   Bursa Uludag University, Medical Faculty, Department of Neurology, Epilepsy and Sleep Unit, Bursa, Turkey.
,
Aylin Bican Demir 
1   Bursa Uludag University, Medical Faculty, Department of Neurology, Epilepsy and Sleep Unit, Bursa, Turkey.
,
Dursun Ceylan 
2   Bilecik State Hospital, Bilecik, Turkey.
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ABSTRACT

Background: It has been reported that 10 to 30% of patients sent to epilepsy centers with a diagnosis of refractory epilepsy are diagnosed with psychogenic non-epileptic seizure (PNES). A wide variety of provocative methods are used to assist PNES diagnosis. Objective: To investigate the effect of seizure induction on the diagnosis and prognosis of PNES. Methods: We retrospectively examined 91 patients with PNES complaints in our video-EEG laboratory. Intravenous saline was administered to all patients for induction of seizures. Results: Saline injection was performed in 91 patients referred to our EEG lab with PNES initial diagnosis, 57 of whom were female and 34 male. Saline injection triggered an attack in 82 patients (90%). Conclusions: In this study we have concluded that provocative methods are practical, cheap and, most of all, effective for patient diagnosis. In clinical practice, explaining the diagnosis is the first and most important step of the treatment, and careful patient-doctor communication has a positive impact on patient prognosis.

RESUMO

Antecedentes: Há relatos de que 10 a 30% dos pacientes com epilepsia refratária enviados a centros de epilepsia são diagnosticados com crise não epiléptica psicogênica (CNEP). Uma ampla variedade de métodos provocativos é usada para auxiliar no diagnóstico de CNEP. Objetivo: Investigar o efeito da indução de convulsões no diagnóstico e no prognóstico de CNEP. Métodos: Examinamos 91 pacientes com queixas de CNEP em nosso laboratório de vídeo-EEG. Foi administrada solução salina intravenosa a todos os pacientes para indução de convulsões. Resultados: A injeção de solução salina foi realizada em 91 pacientes com diagnóstico inicial de CNEP encaminhados ao nosso laboratório de EEG, 57 dos quais eram mulheres e 34 homens. A injeção de solução salina desencadeou um ataque em 82 pacientes (90%). Conclusões: Neste estudo, concluímos que os métodos provocativos são práticos, baratos e, acima de tudo, eficazes para o diagnóstico de pacientes. Na prática clínica, a explicação do diagnóstico é a primeira e mais importante etapa do tratamento, e a comunicação cuidadosa entre médicos e pacientes tem um impacto positivo em seu prognóstico.

Keywords:

Seizures - Saline Solution - Electrocorticography

Palavras-chave:

Convulsões - Solução Salina - Eletrocorticografia

Authors’ contributions:

İB, ABD, DC: idea/concept design; ABD, İB: data collection and/or analysis; ABD, DC: data evaluation, literature search, article writing and critical review.




Publication History

Received: 26 November 2020

Accepted: 24 April 2021

Article published online:
04 July 2023

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