A self-administered screening instrument for psychogenic nonepileptic seizures

Syed, Tanvir U.; Arozullah, Ahsan M.; Loparo, Kenneth A.; Jamasebi, R.; Suciu, Gabriel; Griffin, Curtice R.; Mani, Raghu Nandan; Syed, Ishtiaq; Loddenkemper, Tobias; Alexopoulos, Andreas V.

doi:10.1212/wnl.0b013e3181a55ef7

Cited by 42 publications

(34 citation statements)

References 33 publications

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“…Moreover, a normal interictal electroencephalograph (EEG) does not exclude the diagnosis of epilepsy 17; 18 . Therefore, there is a need to establish other objective, evidence-based methods to diagnose PNES using information obtained early in the patient’s disease course 19 . The standard of care to document PNES is simultaneous video-EEG observation of a typical event 20 .…”

Section: Introductionmentioning

confidence: 99%

“…17,18 Therefore, there is a need to establish other objective, evidence-based methods to diagnose PNES using information obtained early in the patient's disease course. 19 The standard of care to document PNES is simultaneous video-EEG observation of a typical event. 20 Most frequently, PNES are a sign of conversion disorder where patients express and cope with psychological stressors through physical symptoms.…”

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confidence: 99%

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Identifying psychogenic seizures through comorbidities and medication history

et al. 2017

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Summary Objective Low-cost evidence-based tools are needed to facilitate the early identification of patients with possible psychogenic nonepileptic seizures (PNES). Prior to accurate diagnosis, patients with PNES do not receive interventions that address the cause of their seizures and therefore incur high medical costs and disability due to an uncontrolled seizure disorder. Both seizures and comorbidities may contribute to this high cost. Methods Based on data from 1,365 adult patients with video-electroencephalography confirmed diagnoses from a single center, we used logistic and Poisson regression to compare the total number of comorbidities, number of medications and presence of specific comorbidities in five mutually exclusive groups of diagnoses: epileptic seizures (ES) only, PNES only, mixed PNES and ES, physiologic nonepileptic seizure-like events, and inconclusive monitoring. To determine the diagnostic utility of comorbid diagnoses and medication history to differentiate PNES only from ES only, we used multivariate logistic regression, controlling for sex and age, trained using a retrospective database and validated using a prospective database. Results Our model differentiated PNES only from ES only with a prospective accuracy of 78% (95% CI 72–84%) and AUC of 79%. With a few exceptions, the number of comorbidities and medications was more predictive than a specific comorbidity. Comorbidities associated with PNES were asthma, chronic pain and migraines (p<0.01). Comorbidities associated with ES were diabetes mellitus and non-metastatic neoplasm (p<0.01). The population-level analysis suggested that patients with mixed PNES plus ES may be a distinct population from patients with either condition alone. Significance An accurate patient-reported past medical history and medication history can be useful when screening for possible PNES. Our prospectively validated and objective score may assist in the interpretation of the medication and medical history in the context of the seizure description and history.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Identifying psychogenic seizures through comorbidities and medication history

et al. 2017

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“…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%

“…Contrary to widely held belief, PNES commonly manifest with features that are not within the canonical feature list and each patients' peri-ictal behavior can be stereotyped [14][15][16]. Decision algorithms to identify PNES based on peri-ictal behavior and other factors have over 85% accuracy on retrospective populations of up to 227 patients [13,[17][18][19][20][21]. However, recent reports suggest that patient-and witness-reported ictal behavior may not be reliable and that the accuracy of ictal-behavior-based diagnosis is highly dependent on the level of clinical training in seizures [17,22,23].…”

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confidence: 94%

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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“…One particular questionnaire was found useful as a screening tool and can be used to hasten the referral of these patients for (vEEG) [8]. Likewise, semiotics also can be used as a screening tool.…”

Section: Diagnosismentioning

confidence: 99%

Psychogenic Nonepileptic Seizures: What a Neurologist Should Know

Alsaadi¹,

Shahrour²

2014

Health

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Psychogenic nonepileptic seizures (PNES) are episodes of movement, sensation or behavior changes similar to epileptic seizures but without neurological origin. They are somatic manifestations of psychological distress. The aim of this article is to provide a comprehensive review of the practical aspects of this, most often misdiagnosed disorder, which will be of clinical relevance to all practicing neurologists. Patients with PNES are often misdiagnosed and treated for epilepsy for years, resulting in significant morbidity. Video-EEG monitoring is the gold standard for diagnosis. Five to ten percent of outpatient epilepsy populations and 20 to 40 percent of inpatient and specialty epilepsy center patients have PNES. These patients inevitably have comorbid psychiatric illnesses, most commonly depression, post-traumatic stress disorder (PTSD), other dissociative and somatoform disorders, and personality pathology, especially borderline type. Many have a history of sexual and physical abuse. 75 to 85 percent of patients with PNES are women. Although PNES can occur at any age, they typically begin in young adulthood. Treatment involves discontinuing antiepileptic drugs in patients without concurrent epilepsy and referring for appropriate psychiatric care. Additional larger controlled studies to determine the best treatment modalities are needed.

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A self-administered screening instrument for psychogenic nonepileptic seizures

Abstract: We developed and prospectively validated a self-administered psychogenic nonepileptic seizure screening questionnaire that could hasten referral for video electroencephalography and reduce the health and economic burdens from delayed diagnosis or misdiagnosis.

Cited by 42 publications

References 33 publications

Identifying psychogenic seizures through comorbidities and medication history

Identifying psychogenic seizures through comorbidities and medication history

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

Psychogenic Nonepileptic Seizures: What a Neurologist Should Know

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