Differentiation of epilepsy and psychogenic nonepileptic events based on body fluid characteristics

Abstract

ObjectiveDifferential diagnosis between epileptic seizures and psychogenic nonepileptic events (PNEEs) is a worldwide problem for neurologists. The present study aims to identify important characteristics from body fluid tests and develop diagnostic models based on them.MethodsThis is a register‐based observational study in patients with a diagnosis of epilepsy or PNEEs at West China Hospital of Sichuan University. Data from body fluid tests between 2009 and 2019 were used as a training set. We constructed models with a random forest approach in eight training subsets divided by sex and categories of tests, including electrolyte, blood cell, metabolism, and urine tests. Then, we collected data prospectively from patients between 2020 and 2022 to validate our models and calculated the relative importance of characteristics in robust models. Selected characteristics were finally analyzed with multiple logistic regression to establish nomograms.ResultsA total of 388 patients, including 218 with epilepsy and 170 with PNEEs, were studied. The AUROCs of random forest models of electrolyte and urine tests in the validation phase achieved 80.0% and 79.0%, respectively. Carbon dioxide combining power, anion gap, potassium, calcium, and chlorine in electrolyte tests and specific gravity, pH, and conductivity in urine tests were selected for the logistic regression analysis. C (ROC) of the electrolyte and urine diagnostic nomograms achieved 0.79 and 0.85, respectively.SignificanceThe application of routine indicators of serum and urine may help in the more accurate identification of epileptic and PNEEs.

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“…For many of these conditions, a precise medical diagnosis is evident; however, differential diagnosis is more complicated in some cases. Epilepsy, for example, is often misdiagnosed as, or conflated with, syncope or psychogenic nonepileptic seizures, with reports of misdiagnosis as high as 18%-42% (PNES; 268 , 269 ). Epilepsy is a neurological disorder affecting 1% of the population and is characterized by seizures ( 270 ).…”