Electro-clinical Characteristics And Etiology Analysis Of Non-epileptic Seizures

Background Epidemic diseases are a large class of clinical syndromes with sudden,repetitive,and self-limiting characteristics.Epileptic seizures and non-epileptic seizures are important components of epileptic diseases.Because they have similar clinical symptoms,the clinical misdiagnosis rate is extremely high.Although there are literatures at home and abroad describing how to distinguish between seizures and non-epileptic seizures,some non-epileptic seizures take years to be clearly diagnosed,and some are even dia-gnosed as "refractory epilepsy".And applied antiepileptic drugs.To date there are no exact diagnostic criteria for non-epileptic seizures.Scholars at home and abroad agree that long-range video electroencephalography(VEEG)is the gold standard for the diagnosis of non-epileptic seizures.The judgment method is mainly to exclude seizures.There is still no systematic research on the clinical characteristics and etiology of NES,and more Research on NES EEG.Objective Analyze the clinical features and EEG features of non-epileptic seizures,and summarize their etiology to provide a reference for the diagnosis of non-epileptic seizures.Methods A retrospective analysis was made of patients with episodic symptoms as the main complaint and monitoring of VEEG in the general outpatientdepartment of our hospital from December 2017 to December 2019.According to the patient’s clinical symptoms,previous history,signs,and VEEGmonitoring results,combined with the results of imaging,electrocardiogram,psychological tests,routine and special blood tests,the diagnosis was confirmed by 2 neurologists and psychologists,and the etiology diagnosis was improved.Summarize the clinical features of non-epileptic seizures,and analyze the background activity,seizure and inter-seizure EEG characteris-tics of VEEG.Finally,it summarizes the etiology.Results 1.Analysis of the proportion of different types of episodic diseases Seizure symptoms were the main complaints of 644 patients with concurrent VEEG monitoring,of which 345(53.57%)were epilepsy,233(36.18%)were non-epileptic seizures,40(6.21%)were seizures,and 26 were epilepsy.(4.04%).2.NES clinical characteristics analysis The ratio of males to females in NES is 0.78: 1,and there are more females than males.All ages can be affected.There are 30 cases(12.88%)of children aged 0-12,23 cases(9.87%)of teenagers 13-17,18-40 There were 59 cases(25.32%)of young people,41--60 years old had 87 cases(37.34%),and the proportion was the highest,and 34 cases(14.59%)were over 60 years old.The average course of disease was 5 years,with 60 cases(25.75%)under 1 year,100 cases(42.92%)with the highest proportion in 1-5 years,39 cases(16.74%)in 6-10 years and 34 cases over 10(14.59%).The most common seizures were 135 cases(57.94%),of which 73 cases(31.33%)showed PNES as motor seizures,and 62 cases(26.61%)showed physiological seizures with motor seizures.The specific manifestations are head back or turning,upper limb shaking,bilateral limb shaking,belly shaking,unilateral limb tonic-clonic seizure,bilateral limb tonic-clonic seizure,seizure during sleep,invo-luntary movement Limb weakness,cataplexy,and vocalization,with tonic-clonic seizures on both limbs as the most common form of attack.98 cases(42.06%)of non-motor seizures,of which PNES manifested as 10 cases of dynamic seizures(4.29%),and 88 cases(37.77%)of physiological NES manif-ested as motor seizures.The specific manifestations are headache,dizziness,bloating,hallucinations,panic,memory loss,loss of consciousness,and num-bness of the limbs,of which loss of consciousness is the most common.3.NES EEG features Video EEG monitoring results indicate that normal rhythm EEG is the main EEG feature of NES patients;18 cases(7.73%)showed non-specific fast waves(β);20 cases(8.58%)showed non-specific slow waves(θ);57 patients with clinical seizures were all interfering EEG during the same period,and no epilepsy discharge was seen.4.NES etiology analysis The results of this study show that in general clinics,NES attacks caused by physiological factors are the most common,with a total of 150 cases(64.50%),of which 54 cases(23.22%)of syncope are the most common etiology.Types of syncope: Vasovagal syncope and micturition syncope,orthostatic Hypotension syncope,arrhythmic syncope,brain-derived syncope,the next most common cause is non-epileptic seizures,a total of 29 cases(12.47%),the cause of convulsions: hypoglycemia,islet cell tumor,ion disorders,high fever convulsions,alcohol withdrawal syndrome,asthma syndrome,and other causes of NES: 19 cases(8.17%)of transient ischemic attack(TIA),17 cases of migraine(7.31%),14 cases of tic disorder(6.02%)),7 cases of sleep disorder(3.01%),3 cases of transient general forgetting(TGA)(1.29%),4 cases of exercise-induced dystonia(PKD)(1.72%),2 cases of cervical spondylosis(0.86%),systemic 1 case of lupus erythematosus(0.43%);83 cases(35.50%)of PNES caused by mental illness,of which physical or trauma was the most common cause,a total of 47 cases(20.10%),and the other 28 caseswere anxious(11.98%),6 cases of depression(2.56%),2 cases of mania(0.86%).5.Clinical features and etiology analysis of non-epileptic seizures In this study,26 cases of epilepsy coexisted with NES,and two or more seizure symptoms were seen in clinical manifestations.In addition to the stereotypical seizure symptoms,panic attacks and hallucinations were the most common in 8 cases(30.77%),and most were accompanied by anxiety.In addition,seizures are more likely to be misdiagnosed with other organic diseases,such as sleep disorders and hypoglycemia.Other clinical symptoms included: 4 cases(15.38%)of tonic-clonic-like seizures in both limbs,1 case(3.85%)of cataplexy,3 cases of vocalization(11.54%)and 2 cases of headache(7.69%).Etiology of 26 NES patients with epilepsy: the most common mental and psychological diseases,a total of 16 cases(61.54%),including 10 cases of physical or mental trauma,5 cases of anxiety state,1 case of depression state.There were 10 physiological factors(38.48%),including 5 cases of ion disorder,1 case of islet cell tumor,1 case of liver cancer complicated with hypoglycemia,2 cases of migraine,and 1 case of sleep disturbance.Conclusion 1.VEEG is an important basis for diagnosing NES.NES has no characteristic EEG changes during seizures.Background EEG during seizures can be used as a diagnostic reference.2.The clinical features and causes of NES are complex and diverse.Physiological NES takes non-motor hair as the main form of attack.Syncope is the most common cause.PNES uses motor hair as the main form of attack,and physical or psychological trauma is the most common cause.The accompanying symptoms at the onset of NES are of great significance for the diagnosis of the cause.Pay attention to the cause of screening and treatment is the guarantee of NES good prognosis.