Using Semiology to Classify Epileptic Seizures vs Psychogenic Nonepileptic Seizures

被引:15
作者
Muthusamy, Subramanian [1 ,2 ]
Seneviratne, Udaya [1 ,2 ]
Ding, Catherine [2 ]
Thanh G Phan [1 ,2 ]
机构
[1] Monash Univ, Monash Hlth, Sch Clin Sci, Dept Med, Melbourne, Vic, Australia
[2] Monash Med Ctr, Dept Neurol, Melbourne, Vic, Australia
关键词
ICTAL EYE CLOSURE; INTELLECTUAL DISABILITY; DIFFERENTIAL-DIAGNOSIS; VIDEO-EEG; INTERNATIONAL LEAGUE; CHILDREN; EVENTS; PSEUDOSEIZURES; SPECIFICITY; SENSITIVITY;
D O I
10.1212/CPJ.0000000000001170
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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.
引用
收藏
页码:234 / 247
页数:14
相关论文
共 66 条
  • [1] Atypical duration of epileptic and psychogenic nonepileptic events
    Anis, Saar
    Fahoum, Firas
    Korczyn, Amos D.
    Sverdlov, Diana
    Abramovici, Sergiu
    Mina, Yair
    Neufeld, Miri Y.
    Kipervasser, Svetlana
    [J]. EPILEPSY & BEHAVIOR, 2020, 111
  • [2] [Anonymous], 2020, METAANALYSIS DIAGNOS
  • [3] Ictal crying
    Asadi-Pooya, Ali A.
    Wyeth, Dale
    Sperling, Michael R.
    [J]. EPILEPSY & BEHAVIOR, 2016, 59 : 1 - 3
  • [4] Epidemiology of psychogenic nonepileptic seizures
    Asadi-Pooya, Ali A.
    Sperling, Michael R.
    [J]. EPILEPSY & BEHAVIOR, 2015, 46 : 60 - 65
  • [5] Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures?
    Avbersek, Andreja
    Sisodiya, Sanjay
    [J]. JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2010, 81 (07) : 719 - 725
  • [6] Postictal breathing pattern distinguishes epileptic from nonepileptic convulsive seizures
    Azar, Nabil J.
    Tayah, Tania F.
    Wang, Lily
    Song, Yanna
    Abou-Khalil, Bassel W.
    [J]. EPILEPSIA, 2008, 49 (01) : 132 - 137
  • [7] Clinical utility of ictal eyes closure in the differential diagnosis between epileptic seizures and psychogenic events
    Brigo, Francesco
    Ausserer, Harald
    Nardone, Raffaele
    Tezzon, Frediano
    Manganotti, Paolo
    Bongiovanni, Luigi Giuseppe
    [J]. EPILEPSY RESEARCH, 2013, 104 (1-2) : 1 - 10
  • [8] Paroxysmal non-epileptic events in children: A retrospective study over a period of 10 years
    Bye, AME
    Kok, DJM
    Ferenschild, FTJ
    Vles, JSH
    [J]. JOURNAL OF PAEDIATRICS AND CHILD HEALTH, 2000, 36 (03) : 244 - 248
  • [9] Differential diagnosis of staring spells in children: A video-EEG study
    Carmant, L
    Kramer, U
    Holmes, GL
    Mikati, MA
    Riviello, JJ
    Helmers, SL
    [J]. PEDIATRIC NEUROLOGY, 1996, 14 (03) : 199 - 202
  • [10] The misdiagnosis of epilepsy in people with intellectual disabilities: A systematic review
    Chapman, Melanie
    Iddon, Pam
    Atkinson, Kathy
    Brodie, Colin
    Mitchell, Duncan
    Parvin, Garry
    Willis, Steve
    [J]. SEIZURE-EUROPEAN JOURNAL OF EPILEPSY, 2011, 20 (02): : 101 - 106