Diagnostic delay in psychogenic seizures and the association with anti-seizure medication trials
| Autor: | Norma L. Gallardo, Andrew Y. Cho, Andrea M. Chau, Mark S. Cohen, Shannon R. D'Ambrosio, Justine M. Le, John M. Stern, Wesley T. Kerr, Akash B. Patel, Janar Bauirjan, Jessica M. Hori, Emily A. Janio, Jerome Engel |
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| Rok vydání: | 2016 |
| Předmět: |
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Pediatrics Time Factors Delayed Diagnosis Neurodegenerative Epilepsy 0302 clinical medicine 80 and over Psychology Treatment Failure 030212 general & internal medicine Young adult Child Aged 80 and over Medical record General Medicine Middle Aged 3. Good health Diagnostic delay Neurology Neurological Anticonvulsants Female Adult medicine.medical_specialty Adolescent Medication history Antiepileptic drugs Clinical Sciences Article Young Adult 03 medical and health sciences Seizures Clinical Research Psychogenic non-epileptic seizures Non-epileptic seizures medicine Humans Psychogenic disease Aged Neurology & Neurosurgery business.industry Neurosciences Guideline medicine.disease Psychophysiologic Disorders Brain Disorders Psychogenic Seizure Evidence based medicine Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Kerr, WT; Janio, EA; Le, JM; Hori, JM; Patel, AB; Gallardo, NL; et al.(2016). Diagnostic delay in psychogenic seizures and the association with anti-seizure medication trials. SEIZURE-EUROPEAN JOURNAL OF EPILEPSY, 40, 123-126. doi: 10.1016/j.seizure.2016.06.015. UCLA: Retrieved from: http://www.escholarship.org/uc/item/0672w71n |
| ISSN: | 1059-1311 |
| DOI: | 10.1016/j.seizure.2016.06.015 |
| Popis: | Purpose The average delay from first seizure to diagnosis of psychogenic non-epileptic seizures (PNES) is over 7 years. The reason for this delay is not well understood. We hypothesized that a perceived decrease in seizure frequency after starting an anti-seizure medication (ASM) may contribute to longer delays, but the frequency of such a response has not been well established. Methods Time from onset to diagnosis, medication history and associated seizure frequency was acquired from the medical records of 297 consecutive patients with PNES diagnosed using video-electroencephalographic monitoring. Exponential regression was used to model the effect of medication trials and response on diagnostic delay. Results Mean diagnostic delay was 8.4 years (min 1 day, max 52 years). The robust average diagnostic delay was 2.8 years (95% CI: 2.2–3.5 years) based on an exponential model as 10 to the mean of log 10 delay. Each ASM trial increased the robust average delay exponentially by at least one third of a year (Wald t =3.6, p =0.004). Response to ASM trials did not significantly change diagnostic delay (Wald t =−0.9, p =0.38). Conclusion Although a response to ASMs was observed commonly in these patients with PNES, the presence of a response was not associated with longer time until definitive diagnosis. Instead, the number of ASMs tried was associated with a longer delay until diagnosis, suggesting that ASM trials were continued despite lack of response. These data support the guideline that patients with seizures should be referred to epilepsy care centers after failure of two medication trials. |
| Databáze: | OpenAIRE |
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