The A to F of functional status in the acute setting: A scoping review

Eilon, Talia; Elkommos, Samia; Ouzounian, Sevag; Salih, Yousif; Agrawal, Niruj; Yogarajah, Mahinda; Poole, Norman

doi:10.1016/j.seizure.2022.09.015

Cited by 2 publications

(2 citation statements)

References 61 publications

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“…Demographic, clinical and procedural data were extracted from all available documentation including archived emergency medical services (EMS) records. Glasgow Coma Scale (GCS) scores were extracted from EMS documentation and used to categorise initial impairment of responsiveness by severity as mild (13)(14)(15), moderate (9)(10)(11)(12) or severe (3)(4)(5)(6)(7)(8). Semiology of presenting seizures was derived from all available patient documentation including video-EEG and witness reports, and classified into the following categories: 'major motor', which includes hyperkinetic or convulsive seizures; 'minor motor', where motor signs are prominent but limited in spread and severity (eg, isolated tremulous movement of one leg); 'akinetic', which includes syncope-like or stuporous presentations; 'sensory', which includes isolated subjective phenomena (eg, numbness) without motor manifestations or disruption of responsiveness.…”

Section: Data Collection and Clinical Parametersmentioning

confidence: 99%

Dissociative seizures in the emergency room: room for improvement

Cengiz,

Jungilligens,

Michaelis

et al. 2023

J Neurol Neurosurg Psychiatry

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BackgroundDissociative seizures, also known as functional or psychogenic non-epileptic seizures, account for 11%–27% of all emergency seizure presentations. Misdiagnosis as epileptic seizures is common and leads to ineffective and potentially harmful treatment escalations. We assess the potential for diagnostic improvement at different stages of emergency workup and estimate the utility of benzodiazepines.MethodsA retrospective study of all emergency presentations with a discharge diagnosis of acute dissociative seizures seen at a university hospital 2010–2022 was performed to assess clinical characteristics and emergency decision-making.ResultsAmong 156 patients (73% female, median 29 years), 15% presented more than once for a total of 203 presentations. Half of seizures were ongoing at first medical contact; prolonged seizures and clusters were common (23% and 24%). Diagnostic accuracy differed between on-site emergency physicians and emergency department neurologists (12% vs 52%). Typical features such as eye closure, discontinuous course and asynchronous movements were common. Benzodiazepines were given in two-thirds of ongoing seizures, often in high doses and preferentially for major hyperkinetic semiology. Clinical response to benzodiazepines was mixed, with a minority of patients remaining either unaffected (16%) or becoming critically sedated (13%). A quarter of patients given benzodiazepines by emergency medical services were admitted to a monitoring unit, 9% were intubated.ConclusionsImproved semiological assessment could reduce early misdiagnosis of dissociative seizures. Although some seizures seem to respond to benzodiazepines, critical sedation is common, and further studies are needed to assess the therapeutic ratio.

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Section: Data Collection and Clinical Parametersmentioning

confidence: 99%

Dissociative seizures in the emergency room: room for improvement

Cengiz,

Jungilligens,

Michaelis

et al. 2023

J Neurol Neurosurg Psychiatry

View full text Add to dashboard Cite

show abstract

“…This highlights the need for simple educational interventions to reduce diagnostic confusion and ensuing harm. Coupled with the development of guidelines on the acute management of functional seizures, 7 there is the potential to do better for our patients.…”

Section: Dissociative Seizures In the Emergency Department: How To So...mentioning

confidence: 99%

The A to F of functional status in the acute setting: A scoping review

Cited by 2 publications

References 61 publications

Dissociative seizures in the emergency room: room for improvement

Dissociative seizures in the emergency room: room for improvement

Dissociative seizures in the emergency department: how to solve the problem of diagnostic confusion leading to iatrogenic harm?

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