Pseudoseizures And Epilepsy In Neurocysiticercosis: Some Advice For Family Doctors

H. Foyaca-Sibat; L de F Iba?ez-Valdés

摘要

We studied 32 rural patients from the poorest regions in South Africa, diagnosed as epilepsy due to neurocysticercosis presenting pseudoseizures. We found that the common clinical characteristics of this series and its psychological profile such as: duration of events, history of sexual abuse in females, absent of focal neurological signs, vocalization in the middle of the seizures, and lack of post-ictal symptoms were very useful for its differential diagnosis, and the possible difference between the clinical features and psychological profile of those patients and others without PS. Finally, some advices for the management of this condition by family doctors are suggested. Introduction Neurological problems are estimated to comprise 10 to 15 percent of a family physicians workload, and headaches, seizures, and behavior disorders frequently are encountered in primary care, neurology, and psychiatry settings. The specialty of family practice is vitally interested in all aspects of neurological disease. History taking in neurology and performance of the neurological examination are essential skills. Emphasis on good diagnostic and therapeutic skills and appropriate consideration of biopsychosocial factors must be considered as priorities, therefore we need to learn to distinguish in our thinking and in our living, and surely in our practice those expressions of organic lesions of the central nervous system (CNS) from those due to its functional disturbances that characterize neurological, psychiatric, or neuropsychiatry patients in order to provide them a better treatment. To differentiated epileptic seizures (ES) from pseudoseizures (PS) or vice versa that knowledge is crucial, however if both manifestations coincide on the same patient probably other diagnostic tool should be required.PS are sudden changes in behavior that resemble epileptic attack but lack organic cause, and are also known by conversion seizures, disociative seizures, hysterical seizures, psychogenic seizures, and nonepileptic seizures (Bowman E, and Markand O.1999; Bowman ES and Coons PM. 2002). PS are often misdiagnosed and represent the opposite end of the spectrum from seizures that mimic psychiatric disorders without organic cause and an expected EEG changes. Accurately distinguishing PS from EP and other illnesses is difficult because of the breadth and overlap of symptoms seen in each condition and because of the frequent co-occurrence of PS and epilepsy (Bowman ES, 1968). Subjects with PS exhibited trauma-related profiles that differed significantly from those of epileptic comparison subjects and closely resembled those of individuals with a history of traumatic experiences (Fleisher W et al, 2002). PS patients frequently report a history of physical and sexual abuse, and traumatic experience is considered part of the mechanism for producing dissociation and may be a manifestation of dissociative disorders, especially when a history of sexual or physical abuse is documented. (Harden CL ,1997) A controversy currently exists regarding the significance of dissociation and conversion in the pathogenesis of PS. After the abolition of the term “hysterical neurosis” from the current diagnostic systems, these seizures were diagnosed as either Dissociative Disorders (ICD-10) or in the DSM IV as Somatoform disorder, most often of conversion type. The significantly higher incidence of dissociation in the patients with PS suggests dissociation in the pathogenesis of these seizures (Prueter C, 2002).Neurocisticercosis (NCC) is a parasitic infection of central nervous system (CNS) caused by the larval stage (Cysticercus cellulosae) of the pig tapeworm Taenia solium. This is the most common helminthes to produce CNS infection in human being. The occurrence of acquired epilepsy or the syndrome of raised intracranial pressure in a person living in or visiting a region where taeniasis is endemic or even in one living in close contact with people who have taeniasis sho

机译：我们研究了来自南非最贫困地区的32例农村患者，他们被诊断为由于神经囊尾ice病导致假性癫痫发作而癫痫。我们发现该系列的共同临床特征及其心理特征如：事件的持续时间，女性的性虐待史，缺乏局灶性神经系统体征，癫痫发作中的发声和缺乏发作后症状。对于其鉴别诊断非常有用，对于那些和没有PS的患者以及其他患者的临床特征和心理特征可能存在差异。最后，对家庭医生对这种情况的治疗提出了一些建议。引言据估计，神经系统疾病占家庭医生工作量的10％至15％，并且在初级保健，神经病学和精神病学领域经常遇到头痛，癫痫发作和行为障碍。家庭实践的专业对神经系统疾病的各个方面都非常感兴趣。神经病学史和神经学检查表现是必不可少的技能。必须优先重视良好的诊断和治疗技能以及对生物心理因素的适当考虑，因此，我们需要学会在思维和生活中进行区分，并在实践中一定要区分中枢神经系统器质性病变的表现（（CNS）是由于其功能失调而引起的，这些失调是神经，精神病或神经精神病患者的特征，目的是为他们提供更好的治疗。要区分癫痫发作（ES）和假性癫痫（PS）或反之亦然，知识是至关重要的，但是，如果两种表现在同一位患者上同时出现，则可能需要其他诊断工具。PS是行为的突然变化，类似于癫痫发作，但缺乏器质性癫痫发作的原因，也因转换性癫痫，交往性癫痫，歇斯底里性癫痫，精神病性癫痫和非癫痫性癫痫而闻名（Bowman E和Markand O.1999; Bowman ES和Coons PM。2002）。 PS常常被误诊，代表了与癫痫发作相反的发作，癫痫发作模仿了精神疾病而没有器质性原因和预期的EEG变化。由于在每种情况下所见症状的广度和重叠程度，以及PS和癫痫病的频繁并发，很难将PS与EP和其他疾病准确区分开（Bowman ES，1968）。患有PS的受试者表现出与创伤相关的特征，与癫痫比较受试者明显不同，并且与具有创伤经历历史的个体相似（Fleisher W等，2002）。 PS患者经常报告有身体和性虐待的病史，创伤经历被认为是导致解离的机制的一部分，并且可能是解离性疾病的表现，尤其是在有性或身体虐待史的情况下。（Harden CL，1997）目前存在关于在PS的发病机理中解离和转化的重要性的争论。从当前的诊断系统中取消“歇斯底里症”一词后，这些癫痫发作被诊断为解离性障碍（ICD-10）或在DSM IV中被诊断为躯体形式障碍，通常是转化型。 PS患者解离的发生率显着较高，表明这些癫痫发作的发病机理也已解体（Prueter C，2002）。神经istic虫病（NCC）是由幼虫期（Cysticercus cellulosae）引起的中枢神经系统（CNS）寄生虫感染。猪tape虫Ta虫so虫病。这是在人类中引起CNS感染的最常见的蠕虫。生活在或访问虫病流行地区的人，甚至与虫病患者密切接触的人，都会发生后天性癫痫或颅内压升高综合征

Pseudoseizures And Epilepsy In Neurocysiticercosis: Some Advice For Family Doctors

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