Dissociative seizures in the emergency room: room for improvement.

Autor:	Cengiz O; Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany., Jungilligens J; Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany., Michaelis R; Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany., Wellmer J; Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany., Popkirov S; Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany stoyan.popkirov@kk-bochum.de.
Jazyk:	angličtina
Zdroj:	Journal of neurology, neurosurgery, and psychiatry [J Neurol Neurosurg Psychiatry] 2024 Mar 13; Vol. 95 (4), pp. 294-299. Date of Electronic Publication: 2024 Mar 13.
DOI:	10.1136/jnnp-2023-332063
Abstrakt:	Background: Dissociative seizures, also known as functional or psychogenic non-epileptic seizures, account for 11%-27% of all emergency seizure presentations. Misdiagnosis as epileptic seizures is common and leads to ineffective and potentially harmful treatment escalations. We assess the potential for diagnostic improvement at different stages of emergency workup and estimate the utility of benzodiazepines. Methods: A retrospective study of all emergency presentations with a discharge diagnosis of acute dissociative seizures seen at a university hospital 2010-2022 was performed to assess clinical characteristics and emergency decision-making. Results: Among 156 patients (73% female, median 29 years), 15% presented more than once for a total of 203 presentations. Half of seizures were ongoing at first medical contact; prolonged seizures and clusters were common (23% and 24%). Diagnostic accuracy differed between on-site emergency physicians and emergency department neurologists (12% vs 52%). Typical features such as eye closure, discontinuous course and asynchronous movements were common. Benzodiazepines were given in two-thirds of ongoing seizures, often in high doses and preferentially for major hyperkinetic semiology. Clinical response to benzodiazepines was mixed, with a minority of patients remaining either unaffected (16%) or becoming critically sedated (13%). A quarter of patients given benzodiazepines by emergency medical services were admitted to a monitoring unit, 9% were intubated. Conclusions: Improved semiological assessment could reduce early misdiagnosis of dissociative seizures. Although some seizures seem to respond to benzodiazepines, critical sedation is common, and further studies are needed to assess the therapeutic ratio. Competing Interests: Competing interests: SP receives royalties from Springer for a book on functional neurological disorders. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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