epilepsiaEpilepsy and paroxysmal conditionsЭпилепсия и пароксизмальные состояния2077-83332311-4088IRBIS LLC10.17749/2077-8333/epi.par.con.2021.056epilepsia-694Research ArticleSCIENTIFIC SURVEYSНАУЧНЫЕ ОБЗОРЫPsychogenic nonepileptic seizures: to the issue of diagnosis and patient management (with a case report)Психогенные неэпилептические приступы: к вопросу диагностики и тактики ведения пациентов (с описанием клинического наблюдения)https://orcid.org/0000-0003-3635-5850ШоваН. И.ShovaN. I.

Шова Наталья Игоревна – аспирант

Scopus Author ID: 57215893698; РИНЦ SPIN-код: 1952-3043

ул. Бехтерева, д. 3, Санкт-Петербург 192019

Natalia I. Shova – Postgraduate Student

Scopus Author ID: 57215893698; RSCI SPIN-code: 1952-3043

3 Bekhtereva Str., Saint Petersburg 192019

skins_cassi@outlook.comhttps://orcid.org/0000-0002-0356-283XАлексееваД. В.AlekseevaD. V.

Алексеева Диана Владимировна – младший научный сотрудник отделения лечения больных с экзогенно-органическими расстройствами и эпилепсией

Scopus Author ID: 57216917954; РИНЦ SPIN-код: 2331-8682

ул. Бехтерева, д. 3, Санкт-Петербург 192019

Diana V. Alekseeva – Junior Researcher, Department for the Treatment of Patients with Exogenous Organic Disorders and Epilepsy

Scopus Author ID: 57216917954; RSCI SPIN-code: 2331-8682

3 Bekhtereva Str., Saint Petersburg 192019

https://orcid.org/0000-0002-7700-2704МихайловВ. А.MikhailovV. A.

Михайлов Владимир Алексеевич – д.м.н., заместитель директора по инновационному научному развитию, руководитель международного отдела, главный научный сотрудник и научный руководитель отделения лечения органических психических расстройств и эпилепсии и реабилитации пациентов с психосоматическими расстройствами

WoS ResearcherID: B-3272-2017. РИНЦ SPIN-код: 5563-1009

ул. Бехтерева, д. 3, Санкт-Петербург 192019

Vladimir A. Mikhailov – Dr. Med. Sc., Deputy Director for Innovative Scientific Development, Head of the International Department, Chief Researcher and Scientific Director of the Department of Treatment of Organic Mental Disorders and Epilepsy and Rehabilitation of Patients with Psychosomatic Disorders

WoS ResearcherID: B-3272-2017; RSCI SPIN-code: 5563-1009

3 Bekhtereva Str., Saint Petersburg 192019

Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр психиатрии и неврологии им. В. М. Бехтерева» Министерства здравоохранения Российской ФедерацииРоссияBekhterev National Medical Research Centre for Psychiatry and NeurologyRussian Federation202120072021132147156Copyright © Shova N.I., Alekseeva D.V., Mikhailov V.A., 20212021Шова Н.И., Алексеева Д.В., Михайлов В.А.Shova N.I., Alekseeva D.V., Mikhailov V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.epilepsia.su/jour/article/view/694

Establishing misdiagnosis “epilepsy” is a common event comprising 25% total cases of “pharmacoresistant” forms. Eventually, the majority of cases resulted in diagnosing psychogenic nonepileptic seizures, or functional seizures, conversion seizures, and dissociative seizures. Here we review publications assessing psychogenic non-epileptic seizures. The scientific resources for analysis were selected in Russian (eLibrary) and international (Pubmed/MEDLINE, Google Scholar) databases, as well as in open access resources. We also present a clinical case of a patient diagnosed with epilepsy. In particular, the patient was admitted to the hospital with complains of paroxysmal conditions starting as headache, nausea proceeding with speech arrest and decreased mindfulness of what happens in personal life. He also informed about at least two episodes of disorientation described as “missed public transport stop” and “finding himself in unfamiliar place”. The patient underwent examination (electroencephalography, brain magnetic resonance imaging) and dynamic follow-up to verify origin of such conditions. As a result, he was diagnosed with psychogenic non-epileptic seizures. Administering proper therapy allowed to achieve stabilized condition and arrest seizures. The criteria provided in the review as well as clinical case report may help clinical practitioners to timely conduct differential diagnostics and deliver specialized medical aid.

Постановка ошибочного диагноза «эпилепсия» является распространенным явлением и происходит в 25% всех случаев «фармакорезистентных» форм. В конечном итоге большинство случаев завершалось постановкой диагноза «психогенные неэпилептические припадки» или «функциональные приступы», «конверсионные приступы», «диссоциативные конвульсии». В статье представлен обзор литературы по проблеме психогенных неэпилептических припадков. Отбор научных первоисточников для анализа проводили в российской (eLibrary) и зарубежных (PubMed/MEDLINE, Google Scholar) базах данных, а также в открытых источниках. В качестве примера приведено клиническое наблюдение пациента с диагнозом «эпилепсия». Больной поступил в отделение с жалобами на приступообразные состояния, начинающиеся с головной боли, тошноты и протекающие с арестом речи, снижением осознанности происходящего. Кроме того, пациент сообщал о как минимум двух эпизодах дезориентации, когда «проезжал свою остановку в транспорте, обнаруживал себя в незнакомом месте». Проведенное обследование (электроэнцефалография, магнитно-резонансная томография головного мозга) и динамическое наблюдение за больным помогло верифицировать генез данных состояний. В результате поставлен диагноз «психогенные неэпилептические припадки». Путем назначения адекватной терапии удалось достичь стабильности состояния и купировать приступы. Критерии, указанные в литературном обзоре, и клинический пример могут помочь клиницистам своевременно проводить дифференциальную диагностику и оказывать специализированную помощь пациентам.

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The authors declare that there are no conflicts of interest present.