Reliability of reported peri-ictal behavior to identify psychogenic nonepileptic seizures.

Autor:	Kerr WT; Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA; Department of Internal Medicine, Eisenhower Medical Center, Rancho Mirage, CA, USA; Department of Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA. Electronic address: WesleyTK@g.UCLA.edu., Chau AM; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA., Janio EA; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA., Braesch CT; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA., Le JM; Department of Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA., Hori JM; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA., Patel AB; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA., Gallardo NL; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA., Bauirjan J; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA., Allas CH; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA., Karimi AH; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA., Hwang ES; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA., Davis EC; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA., Buchard A; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA., Torres-Barba D; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA., D'Ambrosio S; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA., Al Banna M; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA., Cho AY; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA., Engel J Jr; Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Brain Research Institute, UCLA, Los Angeles, CA, USA., Cohen MS; Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA; Departments of Radiology, Psychology,Biomedical Physics, and Bioengineering, University of California Los Angeles, Los Angeles, CA, USA; California NanoSystems Institute, University of California Los Angeles, Los Angeles, CA, USA., Stern JM; Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
Jazyk:	angličtina
Zdroj:	Seizure [Seizure] 2019 Apr; Vol. 67, pp. 45-51. Date of Electronic Publication: 2019 Mar 05.
DOI:	10.1016/j.seizure.2019.02.021
Abstrakt:	Purpose: Differentiating psychogenic non-epileptic seizures (PNES) from epileptic seizures (ES) can be difficult, even when expert clinicians have video recordings of seizures. Moreover, witnesses who are not trained observers may provide descriptions that differ from the expert clinicians', which often raises concern about whether the patient has both ES and PNES. As such, quantitative, evidence-based tools to help differentiate ES from PNES based on patients' and witnesses' descriptions of seizures may assist in the early, accurate diagnosis of patients. Methods: Based on patient- and observer-reported data from 1372 patients with diagnoses documented by video-elect roencephalography (vEEG), we used logistic regression (LR) to compare specific peri-ictal behaviors and seizure triggers in five mutually exclusive groups: ES, PNES, physiologic non-epileptic seizure-like events, mixed PNES plus ES, and inconclusive monitoring. To differentiate PNES-only from ES-only, we retrospectively trained multivariate LR and a forest of decision trees (DF) to predict the documented diagnoses of 246 prospective patients. Results: The areas under the receiver operating characteristic curve (AUCs) of the DF and LR were 75% and 74%, respectively (empiric 95% CI of chance 37-62%). The overall accuracy was not significantly higher than the naïve assumption that all patients have ES (accuracy DF 71%, LR 70%, naïve 68%, p > 0.05). Conclusions: Quantitative analysis of patient- and observer-reported peri-ictal behaviors objectively changed the likelihood that a patient's seizures were psychogenic, but these reports were not reliable enough to be diagnostic in isolation. Instead, our scores may identify patients with "probable" PNES that, in the right clinical context, may warrant further diagnostic assessment. (Copyright © 2019 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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