Manni Raffaele, Terzaghi Michele, Repetto Alessandra
Unit of Sleep Medicine and Epilepsy, Institute of Neurology, C Mondino Foundation, Pavia, Italy.
Epilepsia. 2008 Sep;49(9):1581-5. doi: 10.1111/j.1528-1167.2008.01602.x. Epub 2008 Apr 10.
To test the usefulness of the FLEP scale in diagnosing nocturnal frontal lobe epilepsy (NFLE), arousal parasomnias, and REM sleep behavior disorder (RBD).
The FLEP scale was applied to 71 subjects (60 male; 11 female; aged 54 +/- 21) referred to an outpatient's sleep and epilepsy unit for diagnostic assessment of nocturnal motor-behavioral episodes, which turned to be arousal parasomnias (11 subjects), NFLE (14 subjects), or idiopathic RBD (46 subjects), based on the findings of in-lab full night video polysomnography with extended EEG montages.
The sensitivity of the scale as a diagnostic test for NFLE was 71.4%, the specificity 100%, the positive predictive value 100%, and the negative predictive value 91.1%. The FLEP scale gave an incorrect diagnosis in 4/71 (5.6%) of the cases, namely NFLE patients with episodes of nocturnal wandering, and uncertain diagnostic indications in 22/71 subjects (30.9%).
The FLEP scale shows high positive and negative predictive values in diagnosing NFLE versus arousal parasomnias and RBD. However, the scale is associated with a real risk of misdiagnosis in some patients and gives uncertain indications in about one-third of cases, mainly RBD. Our investigation highlights the inadequacy of some of the items in the scale. The item investigating wandering, as presently formulated, may be unable to distinguish nocturnal wandering from sleepwalking. The items about "recall" and "clustering" of the events throughout the night may increase the likelihood of mistaking RBD for seizures. Further testing of the reliability of the FLEP scale items appears to be needed.
测试FLEP量表在诊断夜间额叶癫痫（NFLE）、觉醒性异态睡眠和快速眼动睡眠行为障碍（RBD）中的实用性。
FLEP量表应用于71名受试者（60名男性；11名女性；年龄54±21岁），这些受试者因夜间运动行为发作而被转诊至门诊睡眠与癫痫科进行诊断评估，根据实验室全夜视频多导睡眠图及扩展脑电图监测结果，这些发作被诊断为觉醒性异态睡眠（11名受试者）、NFLE（14名受试者）或特发性RBD（46名受试者）。
该量表作为NFLE诊断测试的敏感性为71.4%，特异性为100%，阳性预测值为100%，阴性预测值为91.1%。FLEP量表在4/71（5.6%）的病例中给出了错误诊断，即夜间游走发作的NFLE患者，在22/71名受试者（30.9%）中给出了不确定的诊断指征。
FLEP量表在诊断NFLE与觉醒性异态睡眠和RBD方面显示出较高的阳性和阴性预测值。然而，该量表在一些患者中存在误诊的实际风险，并且在约三分之一的病例中给出不确定的指征，主要是RBD。我们的研究突出了该量表中某些条目的不足之处。目前表述的关于游走的条目可能无法区分夜间游走和梦游。关于事件在整个夜间的“回忆”和“成簇”的条目可能增加将RBD误诊为癫痫发作的可能性。似乎需要进一步测试FLEP量表条目的可靠性。
