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Journal of Neurology

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01-04-2022 | Video-Electroencephalogram | Original Communication

Predictive semiology of psychogenic non-epileptic seizures in an epilepsy monitoring unit

Authors: Andrew J. Duncan, Ivana Peric, Ray Boston, Udaya Seneviratne

Published in: Journal of Neurology | Issue 4/2022

Abstract

Introduction

The diagnosis of psychogenic nonepileptic seizures (PNES) is a common clinical dilemma. We sought to assess the diagnostic value of four ictal signs commonly used in differentiating PNES from epileptic seizures (ES).

Methods

We retrospectively reviewed consecutive adult video-electroencephalogram (VEM) studies conducted at a single tertiary epilepsy center between May 2009 and August 2016. Each event was assessed by a blinded rater for the presence of four signs: fluctuating course, head shaking, hip thrusting, and back arching. The final diagnosis of PNES or ES was established for each event based on clinical and VEM characteristics. All ES were pooled regardless of focal or generalized onset. We analyzed the odds ratio of each sign in PNES in comparison to ES with adjustment for repeated measures using logistic regression. Additionally, we calculated the sensitivity, specificity, predictive values, and likelihood ratios of each sign to diagnose PNES.

Results

A total of 742 events from 140 VEM studies were assessed. Fluctuating course (odds ratio (OR) 37.37, 95% confidence interval (CI) 13.56–102.96, P < 0.0001), head shaking (OR 2.95, 95% CI 1.26–6.79, P = 0.012), and hip thrusting (OR 4.28, 95% CI 1.21–15.18, P = 0.02) were each significantly predictive of PNES. Fluctuating course had the highest sensitivity (76.16%). Back arching (OR 1.06, 95% CI 0.35–3.20, P = 0.92) was not significantly associated with PNES.

Conclusion

Fluctuating course, head shaking, and hip thrusting are semiological features significantly more common in PNES than ES. Fluctuating course is the most reliable sign. Back arching does not appear to differentiate PNES from ES.

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Title: Predictive semiology of psychogenic non-epileptic seizures in an epilepsy monitoring unit
Authors: Andrew J. Duncan
Ivana Peric
Ray Boston
Udaya Seneviratne
Publication date: 01-04-2022
Publisher: Springer Berlin Heidelberg
Keywords: Video-Electroencephalogram
Epilepsy
Non-Epileptic Seizure
Epileptic Seizure
Published in: Journal of Neurology / Issue 4/2022
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-021-10805-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Predictive semiology of psychogenic non-epileptic seizures in an epilepsy monitoring unit

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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