Dikmen Pinar Yalinay, Unlusoy Acar Zeynep, Gurses Candan
Acıbadem University School of Medicine, Istanbul, Turkey.
Neurol Res. 2013 Dec;35(10):1070-5. doi: 10.1179/1743132813Y.0000000249. Epub 2013 Aug 27.
None of the classifications of psychogenic non-epileptic seizures (PNES) have been widely accepted and used by physicians so far. In this study we aimed at classifying PNES on the basis of a modified version of semiological seizure classification (SSC). We also sought to assess the interrater reliability (IRR) of the PNES diagnosis based on SSC.
We classified PNES into four types on the basis of our modification of SSC: pseudoaura, dialeptic, motor, and special (atonic, astatic, hypotonic) spells. Pseudoauras were not included in the statistical analysis. Ninety-one PNES attacks were observed during the 55 video-EEG sessions recorded for all patients. The interrater agreement was assessed by the kappa coefficient.
Twenty-nine women (78·3%) and eight men (21·6%) were surveyed, with a mean age of 28·4 ± 9·6 (range 16-54). The final diagnosis of PNES was established after a mean of 4·5 ± 2·3 years following the onset of PNES attacks in the patients. The mean seizure duration in the PNES was 241 seconds and 40·5% of our patients had PNES longer than 300 seconds. Motor and special PNES were the most common types observed by all the raters. The kappa values for each pair were as follows: Observers I-II 0·51 (p = 0·000), Observers I-III 0·47 (p = 0·000), and Observers II-III 0·73 (p = 0·000).
Interobserver agreement was moderate and substantial for three observers who classified PNES according to our modified SSC. The modified version of SSC could be used without difficulty in classifying PNES. Using SSC for PNES both shortens the period before diagnosis and eliminates the need to learn another new and acceptable classification for PNES.
迄今为止，心理性非癫痫发作（PNES）的分类均未被医生广泛接受和应用。在本研究中，我们旨在基于改良版的癫痫发作症状学分类（SSC）对PNES进行分类。我们还试图评估基于SSC的PNES诊断的评分者间信度（IRR）。
我们在对SSC进行改良的基础上，将PNES分为四种类型：假性先兆、双相性、运动性和特殊（失张力、无静立性、低张力）发作。假性先兆未纳入统计分析。在为所有患者记录的55次视频脑电图检查中，共观察到91次PNES发作。通过kappa系数评估评分者间的一致性。
共调查了29名女性（78.3%）和8名男性（21.6%），平均年龄为28.4±9.6岁（范围16 - 54岁）。患者PNES发作平均4.5±2.3年后确诊为PNES。PNES的平均发作持续时间为241秒，40.5%的患者PNES发作持续时间超过300秒。运动性和特殊型PNES是所有评分者观察到的最常见类型。各评分者间的kappa值如下：观察者I - II为0.51（p = 0.000），观察者I - III为0.47（p = 0.000），观察者II - III为0.
