An objective score to identify psychogenic seizures based on age of onset and history

Kerr, Wesley T.; Janio, Emily A.; Braesch, Chelsea T.; Le, Justine M.; Hori, Jessica M.; Patel, Akash B.; Gallardo, Norma L.; Bauirjan, Janar; Chau, Andrea M.; Hwang, Eric S.; Davis, Emily; Buchard, Albert; Torres-Barba, David; D’Ambrosio, Shannon; Banna, Mona Al; Cho, Andrew Y.; Engel, Jerome; Cohen, Mark S.; Stern, John M.

doi:10.1016/j.yebeh.2017.11.035

Cited by 35 publications

(37 citation statements)

References 85 publications

(85 reference statements)

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“…In particular, seizure duration and frequency can provide valuable information in differentiating PNES from ES. Our mediocre accuracy and predictive values suggested that peri-ictal behaviors should be used in combination with other diagnostic information like comorbidities, medications, clinical history and neurodiagnostics [5,18,20,23,32,35,36]. For the diagnostic certainty to rise above "probable PNES," the patient's seizures need to be captured during EEG or directly observed directly by a clinician familiar with seizure disorders.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, our models may triage patients towards more definitive diagnostic testing. One theme observed in other diagnostic scores is that incorporating information about medical and psychiatric comorbidities as well as trauma history may increase the predictive performance [18,20,31,32]. Therefore, this evaluation should be considered in the appropriate clinical context.…”

Section: Individual-level Predictionsmentioning

confidence: 99%

“…Additionally, the peri-ictal behavior of both ES and PNES were heterogeneous within each diagnostic group, as evidenced by a mildly improved predictive performance of decision forests relative to logistic regression. Identification of these subpopulations may be improved further by considering patients' comorbidities, medications and clinical history [18,32,35,36].…”

Section: Individual-level Predictionsmentioning

confidence: 99%

“…Consequentially, many of the epilepsy-associated peri-ictal behaviors were consistent with mesial temporal lobe epilepsy. When applied to a more general population, we expect the predictive value for PNES to decrease, and predictive values for ES to increase, due to a decreased prevalence of PNES outside of seizure specialty areas and below the age of 10 [32,[39][40][41][42]. Therefore, further validation of our scores in a broader population of patients with seizures is necessary.…”

Section: Future Directions and Limitationsmentioning

confidence: 99%

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Reliability of reported peri-ictal behavior to identify psychogenic nonepileptic seizures

Kerr

Chau

Janio

et al. 2019

Seizure

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A B S T R A C TPurpose: Differentiating psychogenic non-epileptic seizures (PNES) from epileptic seizures (ES) can be difficult, even when expert clinicians have video recordings of seizures. Moreover, witnesses who are not trained observers may provide descriptions that differ from the expert clinicians', which often raises concern about whether the patient has both ES and PNES. As such, quantitative, evidence-based tools to help differentiate ES from PNES based on patients' and witnesses' descriptions of seizures may assist in the early, accurate diagnosis of patients. Methods: Based on patient-and observer-reported data from 1372 patients with diagnoses documented by videoelect roencephalography (vEEG), we used logistic regression (LR) to compare specific peri-ictal behaviors and seizure triggers in five mutually exclusive groups: ES, PNES, physiologic non-epileptic seizure-like events, mixed PNES plus ES, and inconclusive monitoring. To differentiate PNES-only from ES-only, we retrospectively trained multivariate LR and a forest of decision trees (DF) to predict the documented diagnoses of 246 prospective patients. Results: The areas under the receiver operating characteristic curve (AUCs) of the DF and LR were 75% and 74%, respectively (empiric 95% CI of chance 37-62%). The overall accuracy was not significantly higher than the naïve assumption that all patients have ES (accuracy DF 71%, LR 70%, naïve 68%, p > 0.05). Conclusions: Quantitative analysis of patient-and observer-reported peri-ictal behaviors objectively changed the likelihood that a patient's seizures were psychogenic, but these reports were not reliable enough to be diagnostic in isolation. Instead, our scores may identify patients with "probable" PNES that, in the right clinical context, may warrant further diagnostic assessment.

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Section: Discussionmentioning

confidence: 99%

Section: Individual-level Predictionsmentioning

confidence: 99%

Section: Individual-level Predictionsmentioning

confidence: 99%

Section: Future Directions and Limitationsmentioning

confidence: 99%

See 2 more Smart Citations

Reliability of reported peri-ictal behavior to identify psychogenic nonepileptic seizures

Kerr

Chau

Janio

et al. 2019

Seizure

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“…Demographically, PNES patients are more likely to be female (75%) than male and tend to first present during late adolescence to early adulthood. [22][23][24] Though comorbid depression and anxiety are associated with PNES, these are also associated with ES and cannot be used to distinguish PNES from ES. [25][26][27] By contrast, having a personality disorder (particularly cluster B or C) is more common in PNES vs. ES.…”

Section: History-psychogenic Nonepileptic Seizuresmentioning

confidence: 99%

Functional (Psychogenic) Neurological Disorders: Assessment and Acute Management in the Emergency Department

et al. 2019

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Functional neurological disorders (FND, a.k.a. conversion disorder) are increasingly recognized as highly prevalent neurobehavioral-neuropsychiatric conditions. While patients with FND are frequently seen in outpatient neurology and primary care clinics, 1,2 these conditions are also common in emergency department (ED) settings. 3 While large-scale epidemiologic studies of incidence and prevalence are lacking, 4 there is robust evidence of high utilization of primary care, subspecialty, ED, and acute hospital services by patients with FND, resulting in considerable healthcare and societal costs. 5 Notably, patients with FND show elevated repeat ED visit rates in comparison to other conditions. 3 A variety of FND symptoms may lead to ED presentations, particularly those with paroxysmal or acute onset such as psychogenic nonepileptic seizures (PNES, a.k.a. dissociative seizures) or sensorimotor changes that mimic stroke. 6,7 Other FND symptoms that may lead to ED visits include functional movement disorders (FMDs), including functional tremor, gait disturbance, and/or dystonia. Appropriate triage of FND-related cases in the ED is not yet standardized and is often complex, requiring a time-sensitive, concurrent evaluation of neurological emergencies, as well as elements of shared neurology and neuropsychiatry expertise to provide an appropriate disposition and discharge plan.The assessment of FND has traditionally been a lengthy process utilizing tests that are not routinely performed in EDs Keywords ► conversion disorder ► psychogenic nonepileptic seizures ► functional movement disorders ► functional paralysis Abstract Functional neurological disorders (FND) are complex and prevalent neuropsychiatric conditions. Importantly, some patients with FND develop acute onset symptoms requiring emergency department (ED) evaluations. Historically, FND was a "rule-out" diagnosis, making assessment and management in the ED difficult. While the rapid triage of potential neurological emergencies remains the initial task, advancements have altered the approach to FND. FND is now a "rule-in" diagnosis based on validated neurological examination signs and semiological features. In this perspective article, we review signs and semiological features that can help guide the initial assessment of FND in the acute setting. Thereafter, we outline potential approaches to introduce a suspected diagnosis of FND to patients in the ED, while emphasizing the need for a comprehensive neurological evaluation. Physical and occupational therapy may be useful adjunct assessments in some individuals. Notably, clinicians in the ED setting are important members of the interdisciplinary approach to FND.While the clinical history is nonspecific for a diagnosis of FND, certain clues may help raise one's index of suspicion. 15 With regard to FND overall (including functional weakness,

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Prospective multicenter cohort study of possible psychogenic nonepileptic seizure cases—Results at 1‐year follow‐up examinations

et al. 2023

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Objective: The primary purpose of this prospective multicenter study was to examine clinical and demographic feature differences according to the diagnostic level of psychogenic nonepileptic seizures (PNES) and then clarify whether prognosis may also differ accordingly.Methods: Two hundred forty-two consecutive patients strongly suspected of having PNES attacks were invited to participate, of whom 52 did not consent or contact was lost. At the 1-year follow-up examination, PNES diagnosis was reconsidered in nine patients. In 96 patients, the diagnostic level remained the same (P-group), with that in 43 considered to be clinically established (CEgroup) and in 42 documented (D-group). The Qolie-10 and NDDI-E questionnaires were examined at both the study entry and the follow-up examination.Results: Multiple regression analysis of quality of life (QoL) score (n = 173; R 2 = 0.374; F = 7.349; P < 0.001) revealed NDDI-E score (t = −6.402; P < 0.001), age of PNES onset (t = −3.026; P = 0.003), and ethnic minority status (t = 3.068; P = 0.003) as significant contributors. At entry, the P-group showed the lowest PNES attack frequency (P < 0.000), the lowest rate of antiseizure, antidepressant, and antipsychotic medication (P < 0.000; P = 0.031; P = 0.013, respectively), and the lowest proportion of psychosis (P = 0.046). At follow-up, PNES attack frequency (P < 0.000), number of admittances to emergency room (P < 0.000), and scores for QoL (P < 0.000) as well as depression (P = 0.004) were found to be significantly improved together with other collateral indicators, such as rate of antiseizure medication prescription (P = 0.001) and psychiatric symptoms (P = 0.03).Multiple regression analysis of a sample limited to patients with intellectual disability (ID) (n = 44; R 2 = 0.366; F = 4.493; P = 0.002) revealed continued psychotherapy at follow-up (t = 2.610, P = 0.013) and successful reduction in antiseizure medication (t = 2.868; P = 0.007) as positively related with improved QoL.

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An objective score to identify psychogenic seizures based on age of onset and history

Cited by 35 publications

References 85 publications

Reliability of reported peri-ictal behavior to identify psychogenic nonepileptic seizures

Reliability of reported peri-ictal behavior to identify psychogenic nonepileptic seizures

Functional (Psychogenic) Neurological Disorders: Assessment and Acute Management in the Emergency Department

Prospective multicenter cohort study of possible psychogenic nonepileptic seizure cases—Results at 1‐year follow‐up examinations

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