WO2024135881A1 - Information provision method for diagnosing etiology of psychogenic non-epileptic seizures - Google Patents

Abstract

The present invention provides a novel method of providing information according to gender when diagnosing the etiology of psychogenic non-epileptic seizures in children, upon confirming that trauma and learning disability are significant variables in the etiology of psychogenic non-epileptic seizures depending on age and gender.

Description

Information provision method for diagnosing the etiology of psychogenic non-epileptic seizures

The present invention relates to a method of providing information that takes age and gender differences into account in diagnosing the etiology of psychogenic non-epileptic seizures, and can be utilized in the medical field.

Psychogenic non-epileptic seizures (PNES) are seizures that are similar to epileptic seizures, but do not show the electrical discharges seen in epileptic seizures. Psychogenic non-epileptic seizures belong to the category of functional neurological disorders and are recently called functional seizures. Psychogenic non-epileptic seizures are a sign of psychological distress. In other words, PNES is an acquired disorder in which patients may dissociate in response to previous trauma or severe stress. Psychogenic non-epileptic seizures occur disproportionately in women, and the female-to-male ratio is consistently reported to be approximately 3:1. Gender differentiation is reported to become apparent after puberty, usually before the age of 55. Psychogenic non-epileptic seizures begin to increase from puberty and most commonly occur in late adolescence and young adulthood in women. In contrast, men develop PNES at approximately the same rate over their lifetime.

Although the predominance of PNES in women is not fully explained, these results suggest an interaction between age and gender, particularly in the etiology of PNES in women, and data at all ages are needed to understand how gender affects PNES. is needed. Gender differences, especially during puberty, may have important implications for treatment. However, there is currently only one study examining gender differences in the pediatric population with PNES, and this study is examining gender-related differences in clinical demographics and psychosocial functioning in childhood-onset pediatric PNES (Say GN, Tasdemir HA, Ince H. Semiological and psychiatric characteristics of children with psychogenic nonepileptic seizures: Gender-related differences.)

The purpose of the present invention is to provide a method of providing information for diagnosing the etiology of pediatric patients with psychogenic non-epileptic seizures.

1. Providing information that if the pediatric psychogenic non-epileptic seizure is a girl, there is a higher probability that it is due to trauma than if the patient is a boy, and if the patient is a boy, the probability that it is caused by a learning disability is higher than if the patient is a girl; including; A method of providing information for diagnosing the etiology of patients with psychogenic non-epileptic seizures in children.

2. The method of claim 1, wherein the trauma is due to sexual abuse.

The present invention reveals significant differences in psychogenic non-epileptic seizures according to age and gender and provides effective information for diagnosing the etiology of pediatric psychogenic non-epileptic seizure patients. Furthermore, this can be used as a reference in establishing treatment strategies according to the etiology.

Figure 1 is a graphical representation of the Pediatric Symptom Checklist-17 results.

Figure 2 is a graph showing the results of the Pediatric Physical Symptom Test-8. Responses were scored using a 4-point scale from 1 (not at all) to 4 (very much), with bothersome symptoms defined as a single item scored 3 or higher.

Hereinafter, the present invention will be described in detail.

The present invention provides information that, if the pediatric psychogenic non-epileptic seizure is a girl, there is a higher probability that it is due to trauma than if the patient is a boy, and if the patient is a boy, there is a higher probability that it is due to a learning disability than if the patient is a girl; It relates to a method of providing information for diagnosing the etiology of pediatric patients with psychogenic non-epileptic seizures, including:

Seizures refer to temporary seizure changes that occur unexpectedly due to abnormal neural activity, and can be classified into epileptic and non-epileptic.

The above-mentioned psychogenic non-epileptic seizures refer to non-epileptic seizures caused by psychological factors, such as moving the head left and right, impaired consciousness, asynchronous movement of limbs, closed eyes, abnormal muscle tension, etc. There may be symptoms.

In other words, psychogenic non-epileptic seizures are related to psychological mechanisms, such as family dysfunction, school problems, sexual abuse, physical abuse, emotional abuse, witnessing and experiencing violence, sudden death of a loved one, serious accident or illness, refugees, and war. The etiology, including experience, is diverse.

The present invention can provide information according to gender differences in diagnosing the etiology of pediatric psychogenic non-epileptic seizure patients.

The children may include, for example, those over 4, 7, or 8 years of age, and those under 15, 17, 18, or 19 years of age.

Specifically, the present invention analyzed the factors of psychogenic non-epileptic seizures in children based on gender differences and confirmed that trauma and learning disabilities can be significant variables.

This can provide information on the diagnosis of the etiology of psychogenic non-epileptic seizures and can further be used to establish an appropriate treatment strategy based on the diagnosed etiology.

For example, in the case of girls, the probability of psychogenic non-epileptic seizures caused by trauma, specifically sexual abuse, is higher than that of boys, which can be used to establish diagnosis or treatment strategies.

The above-mentioned trauma refers to the symptom of experiencing psychological anxiety by reliving the emotions of the time when something similar to a crisis or fear experienced in the past occurs.

The above sexual abuse refers to forced or illegal sexual abuse and damage that occurs against or against the will of the other person for one's own sexual satisfaction, and includes sexual violence or harsh acts such as sexual harassment, sexual harassment, and sexual assault. do.

For example, in the case of boys, the probability of psychogenic non-epileptic seizures due to learning disabilities is higher than that of girls, which can be used to establish diagnosis or treatment strategies.

The above-mentioned learning disabilities refer to a variety of disabilities that present specific difficulties in the acquisition or use of listening, speaking, reading, writing, reasoning, and arithmetic skills. This may be caused by factors such as genetic predisposition, acquired brain damage, biochemical factors, environmental malnutrition, and nutrition. Learning disabilities are inherent in the individual and are presumed to be caused by damage to the central nervous system.

In addition, the present invention provides information that the probability of suicidal thoughts or suicide attempts in female psychogenic non-epileptic seizure patients is significantly higher than in male psychogenic non-epileptic seizure patients.

The above information can be used, for example, to establish a treatment strategy that intervenes more actively in preventing suicidal thoughts or suicide attempts in female patients with psychogenic non-epileptic seizures than in boys, but is not limited to this.

Hereinafter, the present invention will be described in detail with reference to examples.

Example

1. Patient group and experimental method

We retrospectively reviewed the medical charts of consecutive patients evaluated at the PNES Clinic at Children's Healthcare of Atlanta (CHOA) from July 2019 to March 2020. The PNES Clinic is located within the Department of Pediatric Neurology, Department of Pediatrics, Emory University CHOA. CHOA's PNES Clinic focuses on transitioning patients with PNES from evaluation to treatment. Typical referral sources included neurologists, emergency medical practitioners, in-hospital consultations including EEG monitoring devices, and primary care providers. The clinic team consisted of a pediatric epilepsy specialist (SK) and a licensed clinical social worker (HB). The role of the pediatric epilepsy specialist was to confirm, explain, and communicate the diagnosis of PNES to patients and families. Social workers broadly screen for psychological risk factors through interviews and questionnaires, encourage connections to behavioral health care such as mindfulness and cognitive behavioral therapy, make appropriate referrals, and provide support to families facing barriers to care. provided.

A pediatric epilepsy specialist diagnosed PNES based on clinical history, witnessed events, and electroencephalogram (EEG) findings as suggested by the 2013 International League against Epilepsy (ILAE) Non-Epileptic Seizures Task Force. The task force proposed the following diagnostic levels for PNES: (1) probable PNES as determined by the patient's or witness' clinical history and normal interictal EEG; (2) expected PNES as determined by clinical history, review of a directly witnessed clinician or video recording of the event, and normal interictal EEG; (3) clinically established PNES, as determined by clinical history, clinician witness, and outpatient EEG recording of habitual events without video, and (4) documented PNES as determined by clinical history and video-EEG recording of habitual events.

Children with varying levels of diagnostic certainty of PNES were included in this study. Patients with a concurrent diagnosis of epilepsy were included if a non-epileptic event was captured and confirmed by EEG (n=8). Comorbid epilepsy was defined as epilepsy symptomatology distinct from PNES symptoms, as confirmed by epileptiform discharges between corresponding seizures or epilepsies. During the 9-month study period, 65 patients were scheduled and 51 children presented to the PNES clinic for evaluation. Excluding two patients, 49 patients were enrolled in this study; One patient did not have PNES but had other motor symptoms, and the other patient had only epileptic seizures and a diagnosis of epilepsy.

Demographics (age, gender, race) and clinical variables were collected using patient questionnaires. Clinical variables included age at onset of PNES, frequency of seizures, frequency of emergency department visits in the past year, history of psychiatric diagnosis and medication, severe suicidal thoughts or attempts, concurrent epilepsy or history of epilepsy, learning disability, family history of seizures or mental disorders, and social environment (family). dysfunction and school problems) and history of trauma (sexual and non-sexual abuse). Non-sexual abuse includes physical abuse, emotional abuse, and witnessing or experiencing violence in the family or home. Family dysfunction included divorce or separation, single parenthood, and severe family conflict. Psychosocial functioning and somatic symptoms were also routinely assessed using the Pediatric Symptom Checklist-17 (PSC-17) and Pediatric Somatic Symptom Inventory-8 (CSSI-8).

The PSC-17 is a 17-item questionnaire developed from measures completed by parents to assess psychosocial problems in pediatric patients aged 4 to 18 years. Four scores can be derived from the completed PSC-17: total score, externalizing subscale score, internalizing subscale score, and attention subscale score. The total score ranges from 0 to 34 and is designed to assess the child's overall psychosocial functioning. The higher the score, the greater the risk. A validated cutoff score of _15 on the total score indicates overall mental health risk. A score of _7 indicates risk for both the Attention and Externalizing subscales and a score of _5 indicates risk for the Internalizing subscale. Positive scores are associated with the risk of certain underlying mental health problems. Internalizing items are associated with risk for depression and anxiety, attention items for attention deficit hyperactivity disorder (ADHD), and externalizing items for conduct or oppositional defiant disorder. The Pediatric Symptom Checklist-17 has been thoroughly examined for reliability (internal consistency 0.87-0.89; test-retest 0.85-0.89) and validity.

The CSSI-8 is an 8-item questionnaire to assess physical symptoms over the past 2 weeks in children and adolescents aged 8 to 17 years. These items were derived from the validated 24-item Children's Somatization Test and were used when a simple measurement was needed. Addressed abdominal pain, head, back, arms/legs, fainting/dizziness, fast heartbeat, nausea/stomach issues and weakness. Each item was scored from 1 (not concerned) to 4 (very concerned), and the average score was calculated. Troublesome symptoms were defined as a single item with a score of 3 or higher. Cronbach's alpha was acceptable in the range of 0.75-0.77 in previous studies. All procedures were approved by the CHOA Institutional Review Board (IRB).

2. Statistical analysis method

Frequencies and percentages (%) for categorical variables and medians (min-max) for continuous variables were reported. Fisher's exact test was used to assess associations between categorical variables when applicable. The Mann-Whitney U test was used to compare continuous variables. Data were analyzed using SPSS version 21 (IBM SPSS Inc., Chicago, IL, USA). A two-sided p value <0.05 was considered statistically significant.

3. Target

The most common referral processes were neurologists ( n = 19, 39%), emergency medical providers ( n = 13, 27%), in-hospital consultations ( n = 11, 22%), and primary care physicians ( n = 6 , 12%). EEG was performed in all patients: long-term video-EEG monitoring in 31 patients, routine EEG in 40 patients, and full EEG in 25 patients. The most common level of diagnostic certainty was documented PNES ( n = 29, 60%), with the remainder being probable PNES ( n = 20, 40%). Most patients ( n = 38, 78%) were female and the remaining 11 (22%) were male. Most patients were African American ( n = 32, 65%) and 16 (33%) were white. The median age at onset of PNES symptoms was 14.0 (7-18) years, and the median age at first clinic visit was 15.0 (9-19) years. Median PNES duration was 1.0 (0.1-9.0) years. More than half of patients ( n = 29, 59%) experienced PNES daily or weekly. Concurrent or previous history of epilepsy was found in 8 patients (16%). Learning disabilities were reported in 17 patients (37%). The demographic characteristics of the cohort are summarized in Table 1.

[Table 1]

a Family dysfunction: divorce or separation, single parenthood, serious family conflict, unstable housing.

b Physical abuse, emotional abuse, witnessing or experiencing violence in the family or home, witnessing or experiencing violence in the community, sudden or violent death of a loved one, serious accident or life-threatening illness, refugee and War experiences, homelessness or foster care, bullying.

4. Univariate analysis of clinical variables according to gender

Table 2 shows the results of univariate analysis by gender. Women had more overall trauma/abuse (58% vs 9%, p = 0.01) and suicidal thoughts/attempts (47% vs 1%, p = 0.03), but fewer learning difficulties than men (26% vs 63%). , p = 0.03). Other variables, including race, age at onset of PNES, age at clinic visit, duration of PNES, frequency of emergency room visits in the past year, frequency of episodes, history of antiseizure medication for PNES, past or current mental health medications, family dysfunction, conflict with teachers or peers; There was no difference in family history of seizures or mental illness between men and women.

[Table 2]

a Family dysfunction: divorce or separation, single parenthood, serious family conflict, unstable housing.

b Physical abuse, emotional abuse, witnessing or experiencing violence in the family or home, witnessing or experiencing violence in the community, sudden or violent death of a loved one, serious accident or life-threatening illness, refugee and War experiences, homelessness or foster care, bullying.

*p < 0.05.

5. Psychosocial functioning

Pediatric Symptom Checklist-17 was confirmed in 45 patients. Of these, 24 (53%) had serious behavioral or emotional problems. Patients scoring above the cutoff were most frequent on the internalizing subscale ( n = 21, 47%). A small number of patients ( n = 2, 4%) showed risk within the externalizing subscale ( Fig. 1 ). There was no difference by gender in the PSC-17 analysis. CSSI-8 was identified in 48 patients. Headache was the most common bothersome physical symptom ( n = 20, 42%), followed by limb pain ( n = 13, 27%) and dizziness ( n = 13, 27%) (Figure 2). There was no difference in bothersome physical symptoms between women and men.

Claims (2)

1. If the pediatric psychogenic non-epileptic seizure patient is a girl, there will be a higher probability that it is caused by trauma than if the patient is a boy, and if the patient is a boy, the probability that it is caused by a learning disability will be higher than if the patient is a girl; including; Information provision method for etiological diagnosis in pediatric patients with psychogenic non-epileptic seizures.
2. The method of claim 1, wherein the trauma is caused by sexual abuse.

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