Objective score from initial interview identifies patients with probable dissociative seizures.

Autor: Kerr WT; Department of Neurology, David Geffen School of Medicine at 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, University of California Los Angeles, Los Angeles, CA, USA. Electronic address: WesleyTK@g.UCLA.edu., Janio EA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA., Chau AM; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA., Braesch CT; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA., Le JM; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA., Hori JM; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA., Patel AB; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA., Gallardo NL; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA., Allas CH; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA., Karimi AH; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA., Dubey I; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA., Sreenivasan SS; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA., Bauirjan J; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA., Hwang ES; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA., Davis EC; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA., D'Ambrosio SR; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA., Al Banna M; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; Department of Neurology, University of Minnesota, Minneapolis, MN, USA., Mazumder R; Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA., Wu T; Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA., DeCant ZA; Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA., Gibbs MG; Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA., Chang E; Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA., Zhang X; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA., Cho AY; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA., Beimer NJ; Department of Neurology, University of Michigan, Ann Arbor, MI, USA., Engel J Jr; Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Brain Research Institute, University of California Los Angeles, Los Angeles, California, USA., Cohen MS; Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; Brain Research Institute, University of California Los Angeles, Los Angeles, California, 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 UCLA, Los Angeles, CA, USA.
Jazyk: angličtina
Zdroj: Epilepsy & behavior : E&B [Epilepsy Behav] 2020 Dec; Vol. 113, pp. 107525. Date of Electronic Publication: 2020 Nov 13.
DOI: 10.1016/j.yebeh.2020.107525
Abstrakt: Objective: To develop a Dissociative Seizures Likelihood Score (DSLS), which is a comprehensive, evidence-based tool using information available during the first outpatient visit to identify patients with "probable" dissociative seizures (DS) to allow early triage to more extensive diagnostic assessment.
Methods: Based on data from 1616 patients with video-electroencephalography (vEEG) confirmed diagnoses, we compared the clinical history from a single neurology interview of patients in five mutually exclusive groups: epileptic seizures (ES), DS, physiologic nonepileptic seizure-like events (PSLE), mixed DS plus ES, and inconclusive monitoring. We used data-driven methods to determine the diagnostic utility of 76 features from retrospective chart review and applied this model to prospective interviews.
Results: The DSLS using recursive feature elimination (RFE) correctly identified 77% (95% confidence interval (CI), 74-80%) of prospective patients with either ES or DS, with a sensitivity of 74% and specificity of 84%. This accuracy was not significantly inferior than neurologists' impression (84%, 95% CI: 80-88%) and the kappa between neurologists' and the DSLS was 21% (95% CI: 1-41%). Only 3% of patients with DS were missed by both the fellows and our score (95% CI 0-11%).
Significance: The evidence-based DSLS establishes one method to reliably identify some patients with probable DS using clinical history. The DSLS supports and does not replace clinical decision making. While not all patients with DS can be identified by clinical history alone, these methods combined with clinical judgement could be used to identify patients who warrant further diagnostic assessment at a comprehensive epilepsy center.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE