An objective score to identify psychogenic seizures based on age of onset and history
| Autor: | Andrea M. Chau, Eric S. Hwang, Jessica M. Hori, Emily C. Davis, Janar Bauirjan, Albert Buchard, Justine M. Le, Mark S. Cohen, David Torres-Barba, Jerome Engel, Andrew Y. Cho, Akash B. Patel, Norma L. Gallardo, Shannon R. D'Ambrosio, Mona Al Banna, Wesley T. Kerr, Chelsea T. Braesch, John M. Stern, Emily A. Janio |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
Pediatrics Video Recording Dissociative seizures Logistic regression Neurodegenerative Febrile Behavioral Neuroscience Epilepsy 0302 clinical medicine Outpatient clinic 030212 general & internal medicine Prospective Studies Age of Onset Somatoform Disorders Electroencephalography Middle Aged Health Services Physical abuse Neurology Female Adult medicine.medical_specialty Monitoring Clinical Sciences Dissociative Disorders Article Seizures Febrile 03 medical and health sciences Young Adult Seizures Diagnostic score Clinical Research medicine Psychogenic disease Humans Physiologic Monitoring Physiologic Retrospective Studies Neurology & Neurosurgery Neurosciences medicine.disease Psychogenic Seizure Brain Disorders Sexual abuse Multiple imputation Neurology (clinical) Age of onset 030217 neurology & neurosurgery |
| Popis: | Objective Psychogenic nonepileptic seizure (PNES) is a common diagnosis after evaluation of medication resistant or atypical seizures with video-electroencephalographic monitoring (VEM), but usually follows a long delay after the development of seizures, during which patients are treated for epilepsy. Therefore, more readily available diagnostic tools are needed for earlier identification of patients at risk for PNES. A tool based on patient-reported psychosocial history would be especially beneficial because it could be implemented in the outpatient clinic. Methods Based on the data from 1375 patients with VEM-confirmed diagnoses, we used logistic regression to compare the frequency of specific patient-reported historical events, demographic information, age of onset, and delay from first seizure until VEM in five mutually exclusive groups of patients: epileptic seizures (ES), PNES, physiologic nonepileptic seizure-like events (PSLE), mixed PNES plus ES, and inconclusive monitoring. To determine the diagnostic utility of this information to differentiate PNES only from ES only, we used multivariate piecewise-linear logistic regression trained using retrospective data from chart review and validated based on data from 246 prospective standardized interviews. Results The prospective area under the curve of our weighted multivariate piecewise-linear by-sex score was 73%, with the threshold that maximized overall retrospective accuracy resulting in a prospective sensitivity of 74% (95% CI: 70–79%) and prospective specificity of 71% (95% CI: 64–82%). The linear model and piecewise linear without an interaction term for sex had very similar performance statistics. In the multivariate piecewise-linear sex-split predictive model, the significant factors positively associated with ES were history of febrile seizures, current employment or active student status, history of traumatic brain injury (TBI), and longer delay from first seizure until VEM. The significant factors associated with PNES were female sex, older age of onset, mild TBI, and significant stressful events with sexual abuse, in particular, increasing the likelihood of PNES. Delays longer than 20 years, age of onset after 31 years for men, and age of onset after 40 years for women had no additional effect on the likelihood of PNES. Discussion Our promising results suggest that an objective score has the potential to serve as an early outpatient screening tool to identify patients with greater likelihood of PNES when considered in combination with other factors. In addition, our analysis suggests that sexual abuse, more than other psychological stressors including physical abuse, is more associated with PNES. There was a trend of increasing frequency of PNES for women during childbearing years and plateauing outside those years that was not observed in men. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|