背景:功能性神经障碍(FND)是无法由潜在的神经病变或其他医学疾病解释的神经症状,并且没有明确的神经病理学相关性。精神性非癫痫发作(PNES)是一种常见且高度致残的FND形式,以不自主运动和意识改变的阵发性发作为特征,临床上与癫痫发作相似。PNES在FND中是独特的,因为它们是通过视频脑电图(VEEG)诊断的,该疾病的公认生物标志物。PNES的病程和对治疗的反应仍然存在争议。这项研究旨在描述退伍军人事务部医疗保健系统(VA)中PNES的流行病学,评估退伍军人提供不同治疗的结果,并比较PNES的护理模式。
方法:这项电子健康记录(EHR)队列研究利用信息学搜索工具和自然语言处理算法在全国范围内识别PNES病例。我们将使用VA住院患者,门诊病人,药房,并绘制所有170个医疗中心的抽象数据图表,以识别2002-2018财政年度的病例。结果测量,如癫痫发作频率,急诊室探视,入院,自杀相关行为,PNES诊断前后心理治疗的使用将用于评估护理模式的有效性。
结论:本研究将描述大量PNES患者的危险因素和治疗过程。由于PNES由各种不同的方式照顾,治疗方向,和护理模式,将评估有效性结果,例如癫痫发作结果和癫痫发作紧急访问的利用情况。结果测量,如癫痫发作频率,急诊室探视,入院,自杀相关行为,PNES诊断前后的心理治疗将用于评估护理模式的有效性.
BACKGROUND: Functional neurological disorders (FNDs) are neurological symptoms that cannot be explained by an underlying neurological lesion or other medical illness and that do not have clear neuropathological correlates. Psychogenic non-epileptic seizures (PNES) are a common and highly disabling form of FND, characterized by paroxysmal episodes of involuntary movements and altered consciousness that can appear clinically similar to epileptic seizures. PNES are unique among FNDs in that they are diagnosed by video electroencephalographic (VEEG), a well-established biomarker for the disorder. The course of illness and response to treatment of PNES remain controversial. This
study aims to describe the epidemiology of PNES in the Department of Veterans Affairs Healthcare System (VA), evaluate outcomes of veterans offered different treatments, and compare models of care for PNES.
METHODS: This electronic health record (EHR) cohort
study utilizes an informatics search tool and a natural language processing algorithm to identify cases of PNES nationally. We will use VA inpatient, outpatient, pharmacy, and chart abstraction data across all 170 medical centers to identify cases in fiscal years 2002-2018. Outcome measurements such as seizure frequency, emergency room visits, hospital admissions, suicide-related behavior, and the utilization of psychotherapy prior to and after PNES diagnosis will be used to assess the effectiveness of models of care.
CONCLUSIONS: This
study will describe the risk factors and course of treatment of a large cohort of people with PNES. Since PNES are cared for by a variety of different modalities, treatment orientations, and models of care, effectiveness outcomes such as seizure outcomes and utilization of emergency visits for seizures will be assessed. Outcome measurements such as seizure frequency, emergency room visits, hospital admissions, suicide-related behavior, and psychotherapy prior to and after PNES diagnosis will be used to assess the effectiveness of models of care.