Diagnostic implications of review-of-systems questionnaires to differentiate epileptic seizures from psychogenic seizures

Autor: Norma L. Gallardo, Andrew Y. Cho, Mark S. Cohen, Andrea M. Chau, Justine M. Le, Akash B. Patel, John M. Stern, Wesley T. Kerr, Jerome Engel, Eric S. Hwang, Emily C. Davis, David Torres-Barba, Jessica M. Hori, Janar Bauirjan, Emily A. Janio, Sarah E. Barritt, Chelsea T. Braesch
Rok vydání: 2016
Předmět:
Male
Pediatrics
Comorbidity
Neurodegenerative
Behavioral Neuroscience
Epilepsy
0302 clinical medicine
Surveys and Questionnaires
Diagnosis
Medicine
030212 general & internal medicine
Prospective Studies
Video-electroencephalography
Somatoform Disorders
education.field_of_study
Seizure types
Electroencephalography
Health Services
Prognosis
Computer-diagnostics
Neurology
Review of systems
Neurological
Screening
Pseudoseizures
Female
Adult
medicine.medical_specialty
Population
Clinical Sciences
Article
Diagnosis
Differential
03 medical and health sciences
Clinical Research
Seizures
Psychogenic disease
Humans
education
Psychiatry
Retrospective Studies
Review-of-systems
Neurology & Neurosurgery
business.industry
Neurosciences
Retrospective cohort study
medicine.disease
Psychogenic Seizure
Brain Disorders
Differential
Neurology (clinical)
business
030217 neurology & neurosurgery
Zdroj: Kerr, WT; Janio, EA; Braesch, CT; Le, JM; Hori, JM; Patel, AB; et al.(2017). Diagnostic implications of review-of-systems questionnaires to differentiate epileptic seizures from psychogenic seizures. EPILEPSY & BEHAVIOR, 69, 69-74. doi: 10.1016/j.yebeh.2016.11.002. UCLA: Retrieved from: http://www.escholarship.org/uc/item/4tg6x9jm
ISSN: 1525-5069
DOI: 10.1016/j.yebeh.2016.11.002.
Popis: ObjectiveEarly and accurate diagnosis of patients with psychogenic nonepileptic seizures (PNES) leads to appropriate treatment and improves long-term seizure prognosis. However, this is complicated by the need to record seizures to make a definitive diagnosis. Suspicion for PNES can be raised through knowledge that patients with PNES have increased somatic sensitivity and report more positive complaints on review-of-systems questionnaires (RoSQs) than patients with epileptic seizures. If the responses on the RoSQ can differentiate PNES from other seizure types, then these forms could be an early screening tool.MethodsOur dataset included all patients admitted from January 2006 to June 2016 for video-electroencephalography at UCLA. RoSQs prior to May 2015 were acquired through retrospective chart review (n=405), whereas RoSQs from subsequent patients were acquired prospectively (n=190). Controlling for sex and number of comorbidities, we used binomial regression to compare the total number of symptoms and the frequency of specific symptoms between 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 RoSQs to differentiate PNES only from ES only, we used multivariate logistic regression, controlling for sex and the number of medical comorbidities.ResultsOn average, patients with PNES or mixed PNES and ES reported more than twice as many symptoms than patients with isolated ES or PSLE (p0.1).DiscussionThis analysis of RoSQs confirms that patients with PNES with and without comorbid ES report more symptoms on a population level than patients with epilepsy or PSLE. While these differences help describe the population of patients with PNES, the consistency of RoSQ responses was neither accurate nor specific enough to be used solely as an early screening tool for PNES. Our results suggest that the RoSQ may help differentiate PNES from ES only when, based on other information, the pre-test probability of PNES is at least 50%.
Databáze: OpenAIRE
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