Background and Objectives A misdiagnosis of psychogenic nonepileptic seizures (PNES) and epileptic seizures (ES) is common. In the absence of the diagnostic gold standard (video EEG), clinicians rely on semiology and clinical assessment. However, questions regarding the diagnostic accuracy of different signs remain. This meta-analysis aimed to evaluate the diagnostic accuracy of semiology in PNES and ES. Methods We systematically searched PubMed, PsycInfo, and Medline for original research publications published before 8 February 2021 with no restriction on search dates to identify studies that compared semiology in ES and PNES in epilepsy monitoring units. Non-English publications, review articles, studies reporting on only PNES or ES, and studies limited to patients with developmental delay were excluded. Study characteristics and proportions of event groups and patient groups demonstrating signs were extracted from each article. A bivariate analysis was conducted, and data were pooled in a random effects model for meta-analysis. The I-2 statistic was calculated to assess statistical heterogeneity. The revised Quality Assessment of Diagnostic Accuracy Studies tool was used to assess the risk of bias in induded studies. The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were calculated. A PLR >10 or an NLR <0.1 largely affected the posttest probability of a diagnosis (ES or PNES), whereas a PLR between 5 and 10 or an NLR between 0.1 and 0.2 moderately affected the posttest probability of a diagnosis (ES or PNES). Results The meta-analysis included 14 studies comprising 800 patients with ES and 452 patients with PNES. For PNES, ictal eye closure (PLR 40.5 95% confidence interval [CI] 16.2-101.3; I-2 = 0, from 3 studies) and asynchronous limb movements (PLR 10.2; 95% CI 2.8-37.7; I-2 = 0, from 3 studies) reached a PLR threshold >5. No single sign reached a PLR threshold >5 for ES. Discussion While all signs require an interpretation in the overall clinical context, the presence of ictal eye closure and asynchronous limb movements are reliable discriminative signs for PNES.
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Tel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel
Tel Aviv Univ, Sagol Sch Neurosci, Tel Aviv, IsraelTel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Anis, Saar
Fahoum, Firas
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Tel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, IsraelTel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Fahoum, Firas
Korczyn, Amos D.
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Tel Aviv Univ, Sackler Fac Med, Tel Aviv, IsraelTel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Korczyn, Amos D.
Sverdlov, Diana
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Tel Aviv Univ, Sackler Fac Med, Tel Aviv, IsraelTel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Sverdlov, Diana
Abramovici, Sergiu
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Tel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, IsraelTel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Abramovici, Sergiu
Mina, Yair
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Tel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, IsraelTel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Mina, Yair
Neufeld, Miri Y.
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Tel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, IsraelTel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Neufeld, Miri Y.
Kipervasser, Svetlana
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Tel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, IsraelTel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
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Thomas Jefferson Univ, Dept Neurol, Jefferson Comprehens Epilepsy Ctr, Philadelphia, PA 19107 USAThomas Jefferson Univ, Dept Neurol, Jefferson Comprehens Epilepsy Ctr, Philadelphia, PA 19107 USA
Asadi-Pooya, Ali A.
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Wyeth, Dale
Sperling, Michael R.
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Thomas Jefferson Univ, Dept Neurol, Jefferson Comprehens Epilepsy Ctr, Philadelphia, PA 19107 USAThomas Jefferson Univ, Dept Neurol, Jefferson Comprehens Epilepsy Ctr, Philadelphia, PA 19107 USA
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Thomas Jefferson Univ, Dept Neurol, Jefferson Comprehens Epilepsy Ctr, Philadelphia, PA 19107 USA
Shiraz Univ Med Sci, Shiraz Med Sch, Neurosci Res Ctr, Shiraz, IranThomas Jefferson Univ, Dept Neurol, Jefferson Comprehens Epilepsy Ctr, Philadelphia, PA 19107 USA
Asadi-Pooya, Ali A.
Sperling, Michael R.
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Thomas Jefferson Univ, Dept Neurol, Jefferson Comprehens Epilepsy Ctr, Philadelphia, PA 19107 USAThomas Jefferson Univ, Dept Neurol, Jefferson Comprehens Epilepsy Ctr, Philadelphia, PA 19107 USA
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Manchester Learning Disabil Partnership Qual Res, Manchester M21 7RL, Lancs, EnglandManchester Learning Disabil Partnership Qual Res, Manchester M21 7RL, Lancs, England
Chapman, Melanie
Iddon, Pam
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NHS Manchester, Specialist Nurses Commissioning Team, Primary Care Commissioning, Manchester M14 7LU, Lancs, EnglandManchester Learning Disabil Partnership Qual Res, Manchester M21 7RL, Lancs, England
Iddon, Pam
Atkinson, Kathy
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NHS Manchester, NHS Manchester Lib, Manchester M21 7RL, Lancs, EnglandManchester Learning Disabil Partnership Qual Res, Manchester M21 7RL, Lancs, England
Atkinson, Kathy
Brodie, Colin
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NHS Manchester, NHS Manchester Lib, Manchester M21 7RL, Lancs, EnglandManchester Learning Disabil Partnership Qual Res, Manchester M21 7RL, Lancs, England
Brodie, Colin
Mitchell, Duncan
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Manchester Metropolitan Univ, Manchester M13 0JA, Lancs, EnglandManchester Learning Disabil Partnership Qual Res, Manchester M21 7RL, Lancs, England
Mitchell, Duncan
Parvin, Garry
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Learning Disabil Serv, Joint Commissioning Team, Manchester M21 8UA, Lancs, EnglandManchester Learning Disabil Partnership Qual Res, Manchester M21 7RL, Lancs, England
Parvin, Garry
Willis, Steve
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Manchester Learning Disabil Partnership, S Community Learning Disabil Team, Oakwood Resource Ctr, Manchester M22 4HY, Lancs, EnglandManchester Learning Disabil Partnership Qual Res, Manchester M21 7RL, Lancs, England
机构:
Tel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel
Tel Aviv Univ, Sagol Sch Neurosci, Tel Aviv, IsraelTel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Anis, Saar
Fahoum, Firas
论文数: 0引用数: 0
h-index: 0
机构:
Tel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, IsraelTel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Fahoum, Firas
Korczyn, Amos D.
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h-index: 0
机构:
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, IsraelTel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Korczyn, Amos D.
Sverdlov, Diana
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h-index: 0
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Tel Aviv Univ, Sackler Fac Med, Tel Aviv, IsraelTel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Sverdlov, Diana
Abramovici, Sergiu
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h-index: 0
机构:
Tel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, IsraelTel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Abramovici, Sergiu
Mina, Yair
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Tel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, IsraelTel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Mina, Yair
Neufeld, Miri Y.
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h-index: 0
机构:
Tel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, IsraelTel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Neufeld, Miri Y.
Kipervasser, Svetlana
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h-index: 0
机构:
Tel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, IsraelTel Aviv Sourasky Med Ctr, Dept Neurol, EEG & Epilepsy Unit, Tel Aviv, Israel
机构:
Thomas Jefferson Univ, Dept Neurol, Jefferson Comprehens Epilepsy Ctr, Philadelphia, PA 19107 USAThomas Jefferson Univ, Dept Neurol, Jefferson Comprehens Epilepsy Ctr, Philadelphia, PA 19107 USA
Asadi-Pooya, Ali A.
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h-index:
机构:
Wyeth, Dale
Sperling, Michael R.
论文数: 0引用数: 0
h-index: 0
机构:
Thomas Jefferson Univ, Dept Neurol, Jefferson Comprehens Epilepsy Ctr, Philadelphia, PA 19107 USAThomas Jefferson Univ, Dept Neurol, Jefferson Comprehens Epilepsy Ctr, Philadelphia, PA 19107 USA
机构:
Thomas Jefferson Univ, Dept Neurol, Jefferson Comprehens Epilepsy Ctr, Philadelphia, PA 19107 USA
Shiraz Univ Med Sci, Shiraz Med Sch, Neurosci Res Ctr, Shiraz, IranThomas Jefferson Univ, Dept Neurol, Jefferson Comprehens Epilepsy Ctr, Philadelphia, PA 19107 USA
Asadi-Pooya, Ali A.
Sperling, Michael R.
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h-index: 0
机构:
Thomas Jefferson Univ, Dept Neurol, Jefferson Comprehens Epilepsy Ctr, Philadelphia, PA 19107 USAThomas Jefferson Univ, Dept Neurol, Jefferson Comprehens Epilepsy Ctr, Philadelphia, PA 19107 USA
机构:
Manchester Learning Disabil Partnership Qual Res, Manchester M21 7RL, Lancs, EnglandManchester Learning Disabil Partnership Qual Res, Manchester M21 7RL, Lancs, England
Chapman, Melanie
Iddon, Pam
论文数: 0引用数: 0
h-index: 0
机构:
NHS Manchester, Specialist Nurses Commissioning Team, Primary Care Commissioning, Manchester M14 7LU, Lancs, EnglandManchester Learning Disabil Partnership Qual Res, Manchester M21 7RL, Lancs, England
Iddon, Pam
Atkinson, Kathy
论文数: 0引用数: 0
h-index: 0
机构:
NHS Manchester, NHS Manchester Lib, Manchester M21 7RL, Lancs, EnglandManchester Learning Disabil Partnership Qual Res, Manchester M21 7RL, Lancs, England
Atkinson, Kathy
Brodie, Colin
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h-index: 0
机构:
NHS Manchester, NHS Manchester Lib, Manchester M21 7RL, Lancs, EnglandManchester Learning Disabil Partnership Qual Res, Manchester M21 7RL, Lancs, England
Brodie, Colin
Mitchell, Duncan
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h-index: 0
机构:
Manchester Metropolitan Univ, Manchester M13 0JA, Lancs, EnglandManchester Learning Disabil Partnership Qual Res, Manchester M21 7RL, Lancs, England
Mitchell, Duncan
Parvin, Garry
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h-index: 0
机构:
Learning Disabil Serv, Joint Commissioning Team, Manchester M21 8UA, Lancs, EnglandManchester Learning Disabil Partnership Qual Res, Manchester M21 7RL, Lancs, England
Parvin, Garry
Willis, Steve
论文数: 0引用数: 0
h-index: 0
机构:
Manchester Learning Disabil Partnership, S Community Learning Disabil Team, Oakwood Resource Ctr, Manchester M22 4HY, Lancs, EnglandManchester Learning Disabil Partnership Qual Res, Manchester M21 7RL, Lancs, England