会话分析在鉴别诊断痫性发作与心因性非痫性发作中的作用  

Conversation analysis in differential diagnosis between epileptic seizure and psychogenic nonepileptic seizure

作　　者：姚远 马文[2] Markus Reuber 卢强[1] 黄颜[1] 周祥琴[1] 窦万臣[1] 吴立文[1] 姚雪丽[2] 刘璐[2] 袁一苇 金丽日[1] 

机构地区：[1]中国医学科学院北京协和医院神经科,100730 [2]山东大学临床神经语言学研究中心,250100 [3]Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK

出　　处：《中华神经科杂志》2017年第4期266-270,共5页Chinese Journal of Neurology

摘　　要：目的明确会话分析能否用于汉语患者中痫性发作与心因性非痫性发作的鉴别诊断。方法对2014—2016年就诊于北京协和医院的12例日常使用汉语并疑诊痫性发作或心因性非痫性发作的患者，采用标准化开放性提问流程进行访谈，由语言学家和神经内科医生使用英语、德语患者中总结的17项互动、话题和语言学特征评分表，分别对患者作出诊断，并与最终临床诊断进行对比。结果语言学家和神经内科医生仅依据会话特征，均有10/12患者诊断正确。痫性发作患者的会话特征平均得分为8.00分（语言学家）和6.75分（神经内科医生），心因性非痫性发作患者平均得分则为－5.75分（语言学家）和－7.88分（神经内科医生）。2名研究者单项评分的一致性较高（一致项目占81.86%，167/204）。并以1例额叶癫痫患者与1例心因性非痫性发作患者为例，对比了两组患者的会话特征。结论会话分析可作为汉语患者中鉴别痫性发作与心因性非痫性发作的一种方法。Objective To find out whether conversation analysis helps to differentiate psychogenic nonepileptic seizure （PNES） from epileptic seizure in Chinese patients. Methods Twelve unselected patients from Peking Union Medical College Hospital during 2014 to 2016 with diagnostic uncertainty were included. Interactions following standard protocol were carried out. A linguist blinded to all medical data and a neurologist studied videos and transcripts of the interactions. Using a diagnostic scoring aid which includes 17 conversation features summarized from previous researches, they attempted to predict the medical diagnosis of those patients independently. Results Accurate diagnosis was predicted in 10/12 patients by both raters. Average scores of patients with epileptic seizures were 8.00 （lingulst） and 6. 75 （neurologist） , while average scores of paitents with PNES were -5.75 （linguist） and -7.88 （neurologist）. Both raters agreed on most individual items （81. 86% , 167/204）. To demonstrate different features between these two groups, a case comparison was made between one patient with frontal lobe epilepsy and one patient with PNES. Conclusion In Chinese patients, conversation analysis can help differentiate between epileptic seizure and PNES.

关 键 词：癫痫 发作 心因性非痫性发作 会话分析 

分 类 号：R742.1[医药卫生—神经病学与精神病学]