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Review-of-systems questionnaire as a predictive tool for psychogenic nonepileptic seizures.

ABSTRACT: Patients with refractory epilepsy undergo video-electroencephalography for seizure characterization, among whom approximately 10-30% will be discharged with the diagnosis of psychogenic nonepileptic seizures (PNESs). Clinical PNES predictors have been described but in general are not sensitive or specific. We evaluated whether multiple complaints in a routine review-of-system (ROS) questionnaire could serve as a sensitive and specific marker of PNESs. We performed a retrospective analysis of a standardized ROS questionnaire completed by patients with definite PNESs and epileptic seizures (ESs) diagnosed in our adult epilepsy monitoring unit. A multivariate analysis of covariance (MANCOVA) was used to determine whether groups with PNES and ES differed with respect to the percentage of complaints in the ROS questionnaire. Tenfold cross-validation was used to evaluate the predictive error of a logistic regression classifier for PNES status based on the percentage of positive complaints in the ROS questionnaire. A total of 44 patients were included for analysis. Patients with PNESs had a significantly higher number of complaints in the ROS questionnaire compared to patients with epilepsy. A threshold of 17% positive complaints achieved a 78% specificity and 85% sensitivity for discriminating between PNESs and ESs. We conclude that the routine ROS questionnaire may be a sensitive and specific predictive tool for discriminating between PNESs and ESs.

SUBMITTER: Robles L

PROVIDER: S-EPMC4424090 | biostudies-literature | 2015 Apr

REPOSITORIES: biostudies-literature

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Review-of-systems questionnaire as a predictive tool for psychogenic nonepileptic seizures.

Robles Liliana L Chiang Sharon S Haneef Zulfi Z

Epilepsy & behavior : E&B 20150323

Patients with refractory epilepsy undergo video-electroencephalography for seizure characterization, among whom approximately 10-30% will be discharged with the diagnosis of psychogenic nonepileptic seizures (PNESs). Clinical PNES predictors have been described but in general are not sensitive or specific. We evaluated whether multiple complaints in a routine review-of-system (ROS) questionnaire could serve as a sensitive and specific marker of PNESs. We performed a retrospective analysis of a s ...[more]

PMID: 25812935

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Project description:ObjectiveEarly and accurate diagnosis of patients with psychogenic nonepileptic seizures (PNES) leads to appropriate treatment and improves long-term seizure prognosis. However, this is complicated by the need to record seizures to make a definitive diagnosis. Suspicion for PNES can be raised through knowledge that patients with PNES have increased somatic sensitivity and report more positive complaints on review-of-systems questionnaires (RoSQs) than patients with epileptic seizures. If the responses on the RoSQ can differentiate PNES from other seizure types, then these forms could be an early screening tool.MethodsOur dataset included all patients admitted from January 2006 to June 2016 for video-electroencephalography at UCLA. RoSQs prior to May 2015 were acquired through retrospective chart review (n=405), whereas RoSQs from subsequent patients were acquired prospectively (n=190). Controlling for sex and number of comorbidities, we used binomial regression to compare the total number of symptoms and the frequency of specific symptoms between five mutually exclusive groups of patients: epileptic seizures (ES), PNES, physiologic nonepileptic seizure-like events (PSLE), mixed PNES plus ES, and inconclusive monitoring. To determine the diagnostic utility of RoSQs to differentiate PNES only from ES only, we used multivariate logistic regression, controlling for sex and the number of medical comorbidities.ResultsOn average, patients with PNES or mixed PNES and ES reported more than twice as many symptoms than patients with isolated ES or PSLE (p<0.001). The prospective accuracy to differentiate PNES from ES was not significantly higher than naïve assumption that all patients had ES (76% vs 70%, p>0.1).DiscussionThis analysis of RoSQs confirms that patients with PNES with and without comorbid ES report more symptoms on a population level than patients with epilepsy or PSLE. While these differences help describe the population of patients with PNES, the consistency of RoSQ responses was neither accurate nor specific enough to be used solely as an early screening tool for PNES. Our results suggest that the RoSQ may help differentiate PNES from ES only when, based on other information, the pre-test probability of PNES is at least 50%.

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Review-of-systems questionnaire as a predictive tool for psychogenic nonepileptic seizures.

Publications

Review-of-systems questionnaire as a predictive tool for psychogenic nonepileptic seizures.

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