'Positive' inter-ictal clinical signs of functional neurological disorders are found in patients with functional dissociative seizures.

Autor: Cheval M; Neurology Department, Hopital Avicenne, Assistance Publique, Hôpitaux de Paris, Paris, France.; Epileptology Unit, Reference Center for Rare Epilepsies, Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France., Lapostolle A; Neurology Department, Hopital Avicenne, Assistance Publique, Hôpitaux de Paris, Paris, France., De Liège A; Neurology Department, Hopital Avicenne, Assistance Publique, Hôpitaux de Paris, Paris, France., Tyvaert L; Reference Center for Rare Epilepsies, Neurology Department, University Hospital of Nancy, Nancy, France., Joly C; Neurology Department, Hopital Avicenne, Assistance Publique, Hôpitaux de Paris, Paris, France., Garcin B; Neurology Department, Hopital Avicenne, Assistance Publique, Hôpitaux de Paris, Paris, France.; UPMC UMRS 1127, Inserm U 1127, CNRS UMR 7225, Institut du cerveau et de la moelle épinière (ICM), Paris, France.
Jazyk: angličtina
Zdroj: European journal of neurology [Eur J Neurol] 2024 Oct; Vol. 31 (10), pp. e16430. Date of Electronic Publication: 2024 Aug 03.
DOI: 10.1111/ene.16430
Abstrakt: Background and Purpose: Prior studies highlighted the high diagnostic specificity (ranging from 92% to 100%) of clinical signs observed in functional neurological disorders (FNDs). However, these signs are rarely looked for by epileptologists when trying to distinguish between functional dissociative seizure (FDS) and epileptic seizure. The aim of this study was to determine the prevalence of inter-ictal clinical signs of FND in a cohort of patients with probable FDS. The secondary objective was to compare the prevalence of inter-ictal FND clinical signs in FDS patients with age- and gender-matched epileptic patients without FDS.
Methods: Patients diagnosed with FDS seen at two tertiary care centres and epileptic outpatients were included in the study. Each patient underwent a physical examination, searching for inter-ictal clinical signs of FND.
Results: In the FDS group, 79% of patients presented at least one sign of FND, compared to 16.6% of patients with epilepsy (p < 0.001). Moreover, 66.6% of FDS patients presented three or more FND signs, whereas only 4.1% of epileptic patients did (p < 0.001). The median number of FND clinical signs in the FDS group was four (SD 1.7; 5.5). Using the threshold of three signs or more, the specificity of detecting three or more FND signs was 83.3%, with a sensitivity of 79.2%.
Conclusion: Inter-ictal clinical signs of FND are present in patients with FDS and should be looked for during neurological examination.
(© 2024 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)
Databáze: MEDLINE
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