Leung H, Man C Y, Hui A C F, Wong K S, Kwan P
Department of Medicine and Therapeutics, Division of Neurology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
J Neurol Neurosurg Psychiatry. 2008 Oct;79(10):1144-7. doi: 10.1136/jnnp.2007.139048. Epub 2008 Feb 12.
Differentiating between first seizure, epilepsy and a non-epileptic event is a challenging clinical exercise for many physicians as it may lead to different therapeutic implications. This study aims to investigate the agreement between the initial diagnosis at the accident and emergency (A&E) department and the final diagnosis following inpatient neurological evaluation of seizure disorders.
A prospective observational study between April 2004 and June 2005 in a regional hospital in Hong Kong recruited 1701 patients from the A&E to neurology/medical wards with initial diagnoses/labels matching any one of 12 predefined keywords which were categorised as either "seizure specific" or "non-specific".
Among the 1170 patients with "non-specific" initial diagnoses/labels, 58 (5%) were finally diagnosed as having had a first seizure or epilepsy. Among 531 patients with "seizure specific" initial diagnoses/labels, 27 (5.1%) were subsequently diagnosed as having had non-epileptic events. The kappa value for agreement between the initial and final diagnosis was 0.88. Of the 154 patients with a final diagnosis of first seizure, 34 (22%) had "non-specific" initial labels. Among these patients, components of the evaluation contributing to revision of diagnosis included retrieval of witness accounts (47%), epileptiform discharges on EEG (47%), short term monitoring in patients suspected of acute symptomatic seizures (28%) and panel discussion of cases (22%).
There was generally a high degree of agreement between the initial and final diagnosis, but first seizures were often missed initially. Careful history taking, judicious use of EEG, selective short term monitoring and liaison with specialists are important in reaching an accurate diagnosis.
对许多医生而言，区分首次发作、癫痫和非癫痫性事件是一项具有挑战性的临床工作，因为这可能会导致不同的治疗意义。本研究旨在调查急症室（A&E）的初步诊断与癫痫发作疾病住院神经科评估后的最终诊断之间的一致性。
2004年4月至2005年6月在香港一家地区医院进行的一项前瞻性观察研究，从急症室招募了1701名患者到神经科/内科病房，其初步诊断/标签与12个预定义关键词中的任何一个匹配，这些关键词被归类为“癫痫发作特异性”或“非特异性”。
在1170例具有“非特异性”初步诊断/标签的患者中，58例（5%）最终被诊断为首次发作或癫痫。在531例具有“癫痫发作特异性”初步诊断/标签的患者中，27例（5.1%）随后被诊断为非癫痫性事件。初步诊断与最终诊断之间的一致性kappa值为0.88。在154例最终诊断为首次发作的患者中，34例（22%）最初有“非特异性”标签。在这些患者中，有助于修订诊断的评估内容包括获取证人陈述（47%）、脑电图上的癫痫样放电（47%）、疑似急性症状性发作患者的短期监测（28%）和病例小组讨论（22%）。
初步诊断与最终诊断之间总体上有高度一致性，但首次发作最初常被漏诊。仔细的病史采集、明智地使用脑电图、选择性短期监测以及与专家沟通对于做出准确诊断很重要。
