Duwicquet Coline, de Toffol Bertrand, Corcia Philippe, Bonnin Maxime, El-Hage Wissam, Biberon Julien
Department of Neurology, University Hospital of Tours, France.
Department of Neurology, University Hospital of Tours, France; INSERM U930, Université François-Rabelais de Tours, Tours, France.
Epilepsy Behav. 2017 Dec;77:53-57. doi: 10.1016/j.yebeh.2017.09.013. Epub 2017 Nov 5.
Psychogenic nonepileptic seizures (PNESs) are episodes that resemble epileptic seizures but are of psychological origin. A few studies have attempted to describe different types of PNES as a combination of clinical signs but their validation and robustness have not yet been reached. The aim of this study was to assess the inter-rater reliability (IRR) of five existing clinical PNES classifications.
A total of 107 PNESs from 54 patients were retrospectively analyzed independently by two trained epileptologists, who were blinded to each other's findings. The recorded events were grouped according to the five chosen classifications systems. The IRR was measured using a kappa (κ) coefficient for each PNES classification. We also report category-specific κ values.
Our study demonstrated a mild to moderate IRR (κ from 0.44-0.68) for classifying PNES using the 5 proposed classification schemes. Within these classifications, the most reproducible classes are the subjective ones followed by the dialeptic group. Classes based on motor signs are the least reproducible.
The IRR for current clinical classifications of PNES was only moderate. The difficulty to analyze motor signs could explain this poor reliability. It is necessary to ensure the reliability of clinical classifications of PNES in order for them to be a relevant tool in clinical practice or to explore correlations in clinical research. Future research would benefit from increased precision of diagnostic criteria specific to each class.
心因性非癫痫性发作（PNES）是类似于癫痫发作但起源于心理因素的发作。一些研究试图将不同类型的PNES描述为临床体征的组合，但尚未达到对其验证和稳健性的要求。本研究的目的是评估五种现有的临床PNES分类的评分者间信度（IRR）。
两名经过培训的癫痫专家对来自54例患者的107次PNES进行回顾性独立分析，他们对彼此的结果不知情。记录的事件根据五种选定的分类系统进行分组。使用kappa（κ）系数测量每种PNES分类的IRR。我们还报告了特定类别的κ值。
我们的研究表明，使用5种提议的分类方案对PNES进行分类时，IRR为轻度至中度（κ为0.44 - 0.68）。在这些分类中，最具可重复性的类别是主观类别，其次是对话性类别。基于运动体征的类别可重复性最低。
目前PNES临床分类的IRR仅为中度。分析运动体征的困难可能解释了这种低可靠性。有必要确保PNES临床分类的可靠性，以便使其成为临床实践中的相关工具或用于探索临床研究中的相关性。未来的研究将受益于提高每个类别的诊断标准的精确性。
