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Crises não-epilépticas: clínica e terapêutica Nonepileptic seizures: clinical features and therapeutics

By Guilherme Nogueira Mendes de Oliveira, João Vinícius Salgado, Eduardo Portela, Sílvio Roberto Sousa Pereira and Antônio Lúcio Teixeira

Abstract

Discutir as crises ou os eventos paroxísticos que simulem crises epilépticas, enfatizando as diferenças semiológicas entre elas e as perspectivas terapêuticas. Realizamos uma revisão da literatura, selecionando artigos nas bases de dados Medline e Bireme, a partir dos unitermos: "non-epileptic seizures", "psychogenic seizures". As crises não-epilépticas (CNE) podem ser classificadas em fisiológicas (síncope, migrânea, ataque isquêmico transitório) e em psicogênicas (voluntárias ou não). O padrão-ouro para a diferenciação entre as crises epilépticas e as CNE é o videoeletroencefalograma, mas vários dados semiológicos podem auxiliar esse processo. O tratamento das CNE baseia-se em psicoterapia e em farmacoterapia direcionadas aos transtornos psiquiátricos comórbidos. Apesar de a alta prevalência das CNE e de sua elevada morbidade, são escassos os estudos na literatura nacional. São muitos os desafios diagnósticos e terapêuticos. Assim, o psiquiatra atentar-se à sua ocorrência, evitando iatrogenia, como o uso desnecessário de drogas antiepilépticas.<br>To discuss paroxysmal events that mimic epileptic seizures with emphasis on their semiologic differences and therapeutic perspectives. We did a narrative review of the literature based on selected papers in Medline and Bireme after searching for the uniterms "non-epileptic seizures" and "psychogenic seizures". Nonepileptic seizures (NES) can be classified in physiological (syncope, migraine, transitory ischemic attack) and psychogenic (voluntary or involuntary). The gold-standard in the differentiation of epileptic and nonepileptic seizures is the video-electroencefalogram, but many semiologic features can contribute to this process. The treatment of NES is based mainly on psychotherapy and pharmacotherapy directed to comorbid psychiatric disorders. Despite the high prevalence and elevated morbidity of the NES, there are just few studies on this subject in the Brazilian literature. There are many diagnostic and therapeutic challenges related to NES. Hence, psychiatrists should be aware of the occurrence of NES, avoiding iatrogenic interventions such as the unnecessary administration of anti-epileptic drugs

Topics: Epilepsia, crise não epiléptica, diagnóstico, terapêutica, Epilepsy, nonepileptic seizure, diagnosis, treatment, Psychiatry, RC435-571, Neurology. Diseases of the nervous system, RC346-429, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571, Internal medicine, RC31-1245, Medicine, R, DOAJ:Psychiatry, DOAJ:Medicine (General), DOAJ:Health Sciences
Publisher: Universidade Federal do Rio de Janeiro
Year: 2008
DOI identifier: 10.1590/S0047-20852008000100010
OAI identifier: oai:doaj.org/article:04360cf5f0204e03a98e7cb67a5ad63d
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