Ristić Aleksandar J, Mijović Ksenija, Bukumirić Zoran, Vojvodić Nikola, Janković Slavko, Baščarević Vladimir, Đukić Tijana, Sokić Dragoslav
Center for Epilepsy and Sleep Disorders, Neurology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Serbia.
Medical School, University of Belgrade, Serbia.
Epilepsy Behav. 2017 Feb;67:77-83. doi: 10.1016/j.yebeh.2016.12.022. Epub 2017 Jan 14.
To investigate ability to recognize paroxysmal neurological events (PNE) based on video-recorded events alone in a group of physicians treating prevalent neurological conditions.
Total of 12 patients' videos (6 epileptic seizures (ES), 4 psychogenic nonepileptic seizures (PNES), 2 other nonepileptic seizures (oNES)) were selected. Videos were displayed once to physicians blind to clinical data and final diagnosis. Physicians determined their clinical choice: ES, PNES, oNES, and I don't know (IDK). When ES was chosen, subjects determined type of ES: focal ES, secondary generalized tonic-clonic seizure (GTCS), primary GTCS, and IDK.
In total 145 physicians (62% female, mean age 46.2±9years) (neurologists 58.6%, neuropsychiatrists 25.5%, psychiatrists 5%, and neurology residents 10.3%) were enrolled. Physician's exposure to patients with epilepsy per week was diverse: ≤1 patient (43.7%); 1-7 patients (37.2%); >7 patients (14.5%). Reported frequency of observation of PNE was as follows: frequent (21.4%), sometimes (47.6%); rarely (26.9%); never (2.1%). Majority of subjects were not EEG readers (60.7%). Median percentage (Mdn%) of correct answers (CA) was 75% (range 25-100). Predictor of better PNE recognition was higher frequency of clinical exposure to PNE (OR 1.65; CI95% 1.11-2.45; p=0.013). Mdn% of ES CA was 83.3%, (range 33.3-100), and of PNES CA was 50% (range 0-100). Physicians were more accurate in ES than PNES identification (p<0,001). Mdn% of type of ES CA was 50%, (range 0-100).
We demonstrate the need for education about clinical features of PNE across subgroups of physicians who deliver neurological service, with emphasis on PNES and ES type classification.
调查一组治疗常见神经系统疾病的医生仅根据视频记录的事件识别阵发性神经事件（PNE）的能力。
总共选择了12例患者的视频（6例癫痫发作（ES）、4例精神性非癫痫发作（PNES）、2例其他非癫痫发作（oNES））。视频向不了解临床数据和最终诊断的医生展示一次。医生确定他们的临床选择：ES、PNES、oNES和我不知道（IDK）。当选择ES时，受试者确定ES的类型：局灶性ES、继发性全面强直阵挛发作（GTCS）、原发性GTCS和IDK。
总共招募了145名医生（女性占62%，平均年龄46.2±9岁）（神经科医生占58.6%，神经精神科医生占25.5%，精神科医生占5%，神经科住院医生占10.3%）。医生每周接触癫痫患者的情况各不相同：≤1例患者（43.7%）；1 - 7例患者（37.2%）；>7例患者（14.5%）。报告的观察PNE的频率如下：频繁（21.4%），有时（47.6%），很少（26.9%），从不（2.1%）。大多数受试者不是脑电图阅读者（60.7%）。正确答案（CA）的中位数百分比（Mdn%）为75%（范围25 - 100）。PNE识别能力更强的预测因素是临床接触PNE的频率更高（OR 1.65；CI95% 1.11 - 2.45；p = 0.013）。ES的CA的Mdn%为83.3%（范围33.3 - 100），PNES的CA的Mdn%为50%（范围0 - 100）。医生在识别ES方面比PNES更准确（p<0.001）。ES类型的CA的Mdn%为50%（范围0 - 100）。
我们证明了有必要对提供神经科服务的各亚组医生进行关于PNE临床特征的教育，重点是PNES和ES类型分类。
