Caracterización de los pacientes con eventos paroxísticos psicógenos no epilépticos en la Liga Central contra la Epilepsia en Bogotá-Colombia: variables clínicas y síntomas psiquiátricos asociados
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Introducción: Los eventos paroxísticos psicógenos no epilépticos (EPPNE) constituyen un diagnóstico diferencial en crisis epilépticas, especialmente cuando no responden al manejo médico. Suelen asociarse a síntomas psiquiátricos, sin embargo, existe bajo índice de sospecha y pobre acceso al seguimiento multidisciplinario en estos pacientes. Por lo anterior, no se logra intervenir oportunamente estos factores. Objetivo: Describir el perfil sociodemográfico, presentación clínica, síntomas psiquiátricos asociados y parámetros de seguimiento en una población colombiana con diagnóstico de EPPNE. Metodología: Estudio de prevalencia analítica en el que se tomaron los pacientes adultos con diagnóstico de EPPNE por video-EEG en la Liga Central Contra la Epilepsia entre 2013 y 2016. Se determinó la semiología, curso clínico y se exploraron síntomas psiquiátricos asociados, así como el seguimiento multidisciplinario recibido. Resultados: 53 (6,8%) de 778 pacientes presentaron EPPNE. 85% eran mujeres y 60% tenía diagnóstico de epilepsia. En general, los eventos cursaron con cierre ocular, respuesta a sugestión y elementos motores en extremidades y tronco. 31% declaró no entender el diagnóstico y la mayoría no tenía seguimiento mutidisciplinario. 90,4% tuvo síntomas psiquiátricos, distribuidos así: Somatomorfo (78,1%); Depresivo mayor (59,4%); Pánico (31,3%); Ansiedad (28,1%) y otro síndrome depresivo (15,6%). La edad y la ocupación se asociaron significativamente a estos síntomas. Conclusiones: Los elementos semiológicos característicos de EPPNE fueron: cierre ocular, conciencia no alterada y respuesta a sugestión. Existe una importante asociación entre síntomas psiquiátricos y EPPNE. Se requiere garantizar un diagnóstico e intervención oportuna en estos pacientes, comunicar sus implicaciones de manera efectiva y ofrecer un adecuado seguimiento multidisciplinario.
Abstract. Introduction: Psychogenic nonepileptic seizures (PNES) are a very important differential diagnosis of seizures, especially, when they are refractory to medical management. They usually are associated to psychiatric comorbidity; nevertheless, there is low rate of suspicion and poor access to multidisciplinary follow-up. Therefore, it is not possible to intervene these factors in a timely manner. Purpose: To describe the sociodemographic profile, clinical presentation, associated psychiatric symptoms and follow-up parameters in a Colombian population with diagnosis of PNES. Methodology: This is a cross-sectional study in which we recruited patients referred to the Central League Against Epilepsy with diagnosis of PNES through video-EEG between 2013 and 2016. Semiology and clinical course were determined, associated psychiatric symptoms were explored as well as multidisciplinary follow-up. Results: 53 (6,8%) out of 778 patients had PNES. 85% were female and 60% had epilepsy. In general, the events presented with eye closure, response to suggestion and motor elements in limbs and trunk. 31% declared to don´t understand the diagnosis and majority didn´t have multidisciplinary follow-up. 90.4% had psychiatric symptoms distributed as: Somatoform disorder (78.1%), Major depressive disorder (59.4%), Panic disorder (31,3%); Anxiety (28,1%) and another depressive syndrome (15,6%). Age and occupation were significantly associated to these symptoms. Conclusions: Semiological elements characteristic of PNES were: eye closure, unaltered consciousness and response to suggestion. There is an important association between psychiatric symptoms and PNES. It is necessary to guarantee a diagnosis and timely intervention in these patients, to communicate its implications in an effective way and to offer an appropriate multidisciplinary follow-up.
Abstract. Introduction: Psychogenic nonepileptic seizures (PNES) are a very important differential diagnosis of seizures, especially, when they are refractory to medical management. They usually are associated to psychiatric comorbidity; nevertheless, there is low rate of suspicion and poor access to multidisciplinary follow-up. Therefore, it is not possible to intervene these factors in a timely manner. Purpose: To describe the sociodemographic profile, clinical presentation, associated psychiatric symptoms and follow-up parameters in a Colombian population with diagnosis of PNES. Methodology: This is a cross-sectional study in which we recruited patients referred to the Central League Against Epilepsy with diagnosis of PNES through video-EEG between 2013 and 2016. Semiology and clinical course were determined, associated psychiatric symptoms were explored as well as multidisciplinary follow-up. Results: 53 (6,8%) out of 778 patients had PNES. 85% were female and 60% had epilepsy. In general, the events presented with eye closure, response to suggestion and motor elements in limbs and trunk. 31% declared to don´t understand the diagnosis and majority didn´t have multidisciplinary follow-up. 90.4% had psychiatric symptoms distributed as: Somatoform disorder (78.1%), Major depressive disorder (59.4%), Panic disorder (31,3%); Anxiety (28,1%) and another depressive syndrome (15,6%). Age and occupation were significantly associated to these symptoms. Conclusions: Semiological elements characteristic of PNES were: eye closure, unaltered consciousness and response to suggestion. There is an important association between psychiatric symptoms and PNES. It is necessary to guarantee a diagnosis and timely intervention in these patients, to communicate its implications in an effective way and to offer an appropriate multidisciplinary follow-up.