Vignatelli Luca, Bisulli Francesca, Provini Federica, Naldi Ilaria, Pittau Francesca, Zaniboni Anna, Montagna Pasquale, Tinuper Paolo
Department of Neurological Sciences, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna, Italy.
Epilepsia. 2007 Aug;48(8):1506-11. doi: 10.1111/j.1528-1167.2007.01121.x. Epub 2007 May 1.
Nocturnal frontal lobe seizures (NFLS) show one or all of the following semeiological patterns: (1) paroxysmal arousals (PA: brief and sudden recurrent motor paroxysmal behavior); (2) hyperkinetic seizures (HS: motor attacks with complex dyskinetic features); (3) asymmetric bilateral tonic seizures (ATS: motor attacks with dystonic features); (4) epileptic nocturnal wanderings (ENW: stereotyped, prolonged ambulatory behavior).
To estimate the interobserver reliability (IR) of video-recording diagnosis in patients with suspected NFLS among sleep medicine experts, epileptologists, and trainees in sleep medicine.
Sixty-six patients with suspected NFLS were included. All underwent nocturnal video-polysomnographic recording. Six doctors (three experts and three trainees) independently classified each case as "NFLS ascertained" (according to the above specified subtypes: PA, HS, ATS, ENW) or "NFLS excluded". IR was calculated by means of Kappa statistics, and interpreted according to the standard classification (0.0-0.20 = slight agreement; 0.21-0.40 = fair; 0.41-0.60 = moderate; 0.61-0.80 = substantial; 0.81-1.00 = almost perfect).
The observed raw agreement ranged from 63% to 79% between each pair of raters; the IR ranged from "moderate" (kappa = 0.50) to "substantial" (kappa = 0.72). A major source of variance was the disagreement in distinguishing between PA and nonepileptic arousals, without differences in the level of agreement between experts and trainees.
Among sleep experts and trainees, IR of diagnosis of NFLS, based on videotaped observation of sleep phenomena, is not satisfactory. Explicit video-polysomnographic criteria for the classification of paroxysmal sleep motor phenomena are needed.
夜间额叶癫痫（NFLS）表现出以下一种或全部的症状学模式：（1）阵发性觉醒（PA：短暂且突然反复出现的运动性阵发性行为）；（2）运动过多性癫痫发作（HS：具有复杂运动障碍特征的运动发作）；（3）不对称双侧强直性癫痫发作（ATS：具有张力障碍特征的运动发作）；（4）癫痫性夜间漫游（ENW：刻板、持续的行走行为）。
评估睡眠医学专家、癫痫学家及睡眠医学实习生对疑似NFLS患者进行视频记录诊断时的观察者间可靠性（IR）。
纳入了66例疑似NFLS患者。所有患者均接受夜间视频多导睡眠图记录。6名医生（3名专家和3名实习生）独立将每个病例分类为“确诊NFLS”（根据上述指定亚型：PA、HS、ATS、ENW）或“排除NFLS”。通过Kappa统计量计算IR，并根据标准分类进行解释（0.0 - 0.20 = 轻度一致；0.21 - 0.40 = 一般；0.41 - 0.60 = 中度；0.61 - 0.80 = 高度；0.81 - 1.00 = 几乎完全一致）。
各评分者之间观察到的原始一致性范围为63%至79%；IR范围从“中度”（kappa = 0.50）到“高度”（kappa = 0.72）。主要的差异来源是在区分PA和非癫痫性觉醒方面存在分歧，专家和实习生之间的一致程度没有差异。
在睡眠专家和实习生中，基于对睡眠现象的视频观察诊断NFLS的IR并不令人满意。需要明确的视频多导睡眠图标准来对阵发性睡眠运动现象进行分类。
