Clinical Features Of Epilepsy And Psychogenic Non-epileptic Seizures And The Value Of Video Electroencephalography In Differential Diagnosis

Objective: Psychogenic non-epileptic seizures(PNES)and epilepsy(EP)are sometimes difficult to distinguish clinically,and are easily misdiagnosed as epilepsy,and epilepsy is occasionally misdiagnosed as psychogenic non-epileptic seizures.Psychogenic non-epileptic seizures are also uncommon,so the clinical distinction between psychogenic non-epileptic seizures and epilepsy is sometimes challenging.However,some typical clinical features of the two are helpful to distinguish psychogenic non-epileptic seizures from epilepsy,and video EEG plays an important role in the differential diagnosis of the two.To explore the clinical similarities and differences between epilepsy and psychogenic non-epileptic seizures and the value of video EEG and language elicitation test in the differential diagnosis of the two patients,so as to provide a reference for the diagnosis and treatment of epilepsy and psychogenic non-epileptic seizures.Methods: The cases of patients with episodic convulsions and disturbance of consciousness as the main symptoms who came to our department for treatment and underwent video EEG examination from April 2020 to October 2021 were collected.Follow-up results,combined with the two diagnostic criteria,a clear diagnosis of epilepsy or psychogenic non-epileptic seizures.According to the inclusion and exclusion criteria,50 patients diagnosed with the two diseases were included in the EP group and the PNES group,respectively.The clinical characteristics,video EEG and language elicitation test results of the two groups were analyzed and compared.Results:1.In terms of general information,there were differences in gender and age of onset between the two groups of patients,and the differences were statistically significant(P<0.05);2.In terms of social and psychological factors,there are differences between the two groups in psychological trauma,sexual abuse,physical abuse,parental divorce,and the death of relatives,and the difference is statistically significant(P<0.05);3.In terms of predisposing factors,there were differences in mood changes,colds and colds between the two groups,and the differences were statistically significant(P<0.05);4.In terms of clinical characteristics before the attack,there were differences between the two groups in the sense of rushing stomach qi,flashes or black spots in front of the eyes,and the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that flashes or black spots were risk factors for epilepsy(OR=0.006,95%CI=0.001-0.046,P<0.05);5.In terms of the clinical characteristics of the attack period,the two groups were crying and tearing,answering questions,eyes open and closed,eyelid tremor,trismus,tongue bite,left and right shaking,synchronous limb movements,pelvic lift,trunk twisting,seizure pattern,There were differences in onset,duration and recall of onset during sleep,and the difference was statistically significant(P<0.05).Multivariate logistic regression analysis showed that eye opening and eye closing during seizures were risk factors for epilepsy and PNES,respectively(OR=0.075,95%CI=0.010-0.563,P<0.05);5.In terms of the symptoms of autonomic nervous function associated with the attack,there were differences in the two groups in the rapid heart rate,sweating,shortness of breath,and urinary incontinence,and the difference was statistically significant(P<0.05).Multivariate logistic regression analysis showed that urinary incontinence was a risk factor for epilepsy(OR=0.107,95%CI=0.013-0.892,P<0.05);6.In terms of clinical characteristics after the attack,there were differences in headache and fatigue between the two groups,and the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that headache after seizure was a risk factor for epilepsy(OR=0.148,95%CI=0.031-0.706,P<0.05);7.In terms of co-morbid migraine,there were differences between the two groups,and the difference was statistically significant(P<0.05);8.In the interictal video EEG,the two groups have differences in the discharge of spikes,spikes and slow waves,sharp waves,and sharp and slow waves,and the difference is statistically significant(P<0.05).Multivariate logistic regression analysis was used.It showed that spike and slow waves were risk factors for epilepsy(OR=0.031,95%CI=0.004-0.240,P<0.05),area under the AUC curve=0.690,95%CI=0.585-0.795,It shows that the spike and slow waves have a certain predictive value for the diagnosis of epilepsy.A variety of typical characteristic epileptic discharges can be seen in epilepsy patients during ictal period,while PNES patients show motion artifact and alpha activity caused by seizures,and none of them have symptom-related epileptic discharges.Conclusion:1.Patients with epilepsy and psychogenic non-epileptic seizures have significantly different clinical manifestations,especially the flashes or black spots in front of the eyes before the attack,the state of eyes open and closed during the attack,urinary incontinence and headache after the attack have obvious differential diagnosis value for the two.It is recommended that patients’ family members and clinicians conduct mobile phone video recordings of episodic diseases to help identify them.2.The appearance of abnormal spikes and slow waves in the video EEG monitoring results can help distinguish epilepsy from psychogenic non-epileptic seizures,and language elicitation test can further play a role in the identification.