Conversation analysis can help to distinguish between epilepsy and non-epileptic seizure disorders: A case comparison

Plug, Leendert; Sharrack, Basil; Reuber, Markus

doi:10.1016/j.seizure.2008.06.002

Cited by 50 publications

(32 citation statements)

References 31 publications

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“…Research initially carried out in Germany but then also in the United Kingdom and elsewhere showed that patients with epilepsy tend to focus on their subjective seizure experiences and expend considerable effort to explain exactly how they feel in their seizures; in contrast, those with PNES preferentially focus on the circumstances in which their seizures occurred or the consequences of their seizures [50][51][52][53]. The metaphoric conceptualisations of seizure experiences preferred by patients with epilepsy place the linguistic agency with the seizure, which acts independently and often in a hostile fashion (eg.…”

Section: Interactional Representationmentioning

confidence: 99%

Understanding psychogenic nonepileptic seizures—Phenomenology, semiology and the Integrative Cognitive Model

Reuber

Brown

2017

Seizure

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Section: Interactional Representationmentioning

confidence: 99%

Understanding psychogenic nonepileptic seizures—Phenomenology, semiology and the Integrative Cognitive Model

Reuber

Brown

2017

Seizure

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“…T grounded in the qualitative methodology of Conversation Analysis (CA) [17][18][19], identified two contrasting conversational profiles which were closely linked to patients' medical diagnoses: whereas patients with epilepsy were likely to volunteer detailed talk about subjective seizures symptoms, patients with PNES tended to avoid symptom descriptions and to focus on the circumstances or consequences of their seizures [20]. In later studies linguists were shown to be able to use these features accurately to predict a is [21], with linguistic raters correctly predicting 85% of diagnoses subsequently confirmed by video-EEG. In contrast, only 40% of the working diagnoses formulated by the ior to admission were supported by the video-EEG findings [21].…”

Section: Previous Linguistic and Interactional Findingsmentioning

confidence: 99%

“…In later studies linguists were shown to be able to use these features accurately to predict a is [21], with linguistic raters correctly predicting 85% of diagnoses subsequently confirmed by video-EEG. In contrast, only 40% of the working diagnoses formulated by the ior to admission were supported by the video-EEG findings [21]. However, it has also been shown that the conversational features which the linguistic raters used to make their diagnostic predictions require doctors to adopt the unusually open style of questioning used in the original research studies.…”

Section: Previous Linguistic and Interactional Findingsmentioning

confidence: 99%

“…Inspired by the 17-item Diagnostic Scoring Aid (DSA) developed previously to guide the posthoc analysis of transcripts and video-recordings of doctor-patient encounters by conversation analysts [21], we developed a much simpler questionnaire designed to guide doctors to reflect on interactional and linguistic features immediately after a clinical encounter with a seizure patient presenting for their first appointment.…”

Section: Linguistic Features Questionnairementioning

confidence: 99%

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Neurologists can identify diagnostic linguistic features during routine seizure clinic interactions: results of a one-day teaching intervention

Jenkins

Cosgrove

Chappell

et al. 2016

Epilepsy & Behavior

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The diagnostic distinction between epilepsy and psychogenic nonepileptic seizures (PNES) can be challenging. Previous studies have demonstrated that conversation analysts can identify linguistic and interactional features in transcripts and recordings of interviews with seizure patients that reliably distinguish between epilepsy and PNES. In this study, ten senior neurology trainees took part in a one-day intervention workshop about linguistic and interactional differences in the conversation behaviour of patients with epilepsy and those with PNES. Participants were familiarised with a 12-item questionnaire designed to capture their conversational observations immediately after talking to a patient with seizures. After the intervention, 55 initial outpatient visits of patients referred to seizure clinics were video and audio recorded. All medical diagnoses were confirmed two years after initial presentation on the basis of a chart review (including MRI and EEG findings) by a fully trained epilepsy expert. Post-visit questionnaires relating to patients confirmed to have epilepsy (n=20) or PNE" Dinteractional observations differed significantly between the epilepsy and PNES groups. Receiver operating curve analysis showed that a summation scale based on items demonstrating significant between-group differences correctly classified 81.8% of patients as having epilepsy or PNES. This study shows that a brief Conversation Analytic teaching intervention can enable neurologists to identify linguistic and interactional features supporting the differentiation of epilepsy and PNES as diagnostic accuracy.

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“…Two contrasting conversational profiles matching patients' medical diagnoses emerged: whereas patients with epilepsy were likely to volunteer detailed talk about subjective seizures symptoms, patients with NES tended to avoid symptom descriptions and instead focus on the circumstances or consequences of their seizures (Schwabe et al, 2008). The incomplete seizure narratives and inability or unwillingness to topicalize seizure symptoms typical of NES patients (rather than a preferred focus on the situations in which seizures occur or the consequences of seizures) become particularly clear when they are prompted to speak about particularly memorable seizure episodes such as their first, last or worst seizure (for an exemplary case comparison see Plug et al, 2009). These findings do not seem language dependent: having initially been noted in German speaking patients (Schwabe et al, 2008), they have been replicated in clinical encounters with Italian speakers (Cornaggia et al, 2012).…”

Section: Linguistic Features Can Be Used To Distinguish Between Epilementioning

confidence: 99%

A brief conversation analytic communication intervention can change history-taking in the seizure clinic

Jenkins

Cosgrove

Ekberg

et al. 2015

Epilepsy & Behavior

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Article available under the terms of the CC-BY-NC-ND licence (https://creativecommons.org/licenses/by-nc-nd/4.0/) eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ Reuse Unless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version -refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher's website. Takedown AbstractQuestion design during history-taking has clear implications for share their concerns in general, and their seizure experiences in particular. Studies have shown that unusually open questions at the start of the consultation enable patients to display interactional and linguistic markers which may help with the otherwise challenging differentiation of epileptic from non-epileptic seizures (NES). In this study, we compared the problem presentation approach taken by trainee neurologists in outpatient encounters with new patients before and after a one-day conversation analytic training intervention in which an open format of question design and recognise diagnostically relevant linguistic features. We audio/video-recorded clinical encounters between ten doctors, their patients and accompanying persons, transcribed the interactions, and carried out quantitative and qualitative analyses. We studied 39 encounters before and 55 after the intervention. Following the intervention, doctors were significantly more likely to use a non-directive approaches to soliciting patient accounts of their presenting complaints that invited the patient to describe their problems from their own point of view and gave them better opportunity to determine the initial agenda of the encounter. The time to first interruption by the doctor increased (from 52 to 116 seconds, p<.001). Whilst patients were given more time to describe their seizure experiences, the overall appointment length did not increase significantly (19 vs 21 minutes, n.s.). These changes gave patients more conversational space to express their concerns and, potentially, to demonstrate the interactional and linguistic features previously found to help differentiate between epilepsy and NES, without impacting the length of the consultations.2

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Conversation analysis can help to distinguish between epilepsy and non-epileptic seizure disorders: A case comparison

Abstract: This study illustrates the importance of the time point at which patients share information with the doctor. It supports the notion that close attention to how patients communicate can help in the differential diagnosis of seizures.

Cited by 50 publications

References 31 publications

Understanding psychogenic nonepileptic seizures—Phenomenology, semiology and the Integrative Cognitive Model

Understanding psychogenic nonepileptic seizures—Phenomenology, semiology and the Integrative Cognitive Model

Neurologists can identify diagnostic linguistic features during routine seizure clinic interactions: results of a one-day teaching intervention

A brief conversation analytic communication intervention can change history-taking in the seizure clinic

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