Tyson Brad T, Baker Shannon, Greenacre Matthew, Kent Katrina J, Lichtenstein Jonathan D, Sabelli Alana, Erdodi Laszlo A
Neuroscience Institute, EvergreenHealth Medical Center, Kirkland, WA, USA.
Schulich School of Medicine, Western University, London, ON, Canada.
Epilepsy Behav. 2018 Oct;87:39-45. doi: 10.1016/j.yebeh.2018.08.010. Epub 2018 Aug 29.
Differentiating epileptic seizures (ES) from psychogenic nonepileptic seizures (PNES) represents a challenging differential diagnosis with important treatment implications. This study was designed to explore the utility of neuropsychological test scores in differentiating ES from PNES.
Psychometric data from 72 patients with ES and 33 patients with PNES were compared on various tests of cognitive ability and performance validity. Individual measures that best discriminated the diagnoses were then entered as predictors in a logistic regression equation with group membership (ES vs. PNES) as the criterion.
On most tests of cognitive ability, the PNES sample outperformed the ES sample (medium-large effect) and was less likely to fail the Reliable Digit Span. However, patients with PNES failed two embedded validity indicators at significantly higher rates (risk ratios (RR): 2.45-4.16). There were no group differences on the Test of Memory Malingering (TOMM). A logistic regression equation based on seven neuropsychological tests correctly classified 85.1% of patients. The cutoff with perfect specificity was associated with 0.47 sensitivity.
Consistent with previous research, the utility of psychometric methods of differential diagnosis is limited by the complex neurocognitive profiles associated with ES and PNES. Although individual measures might help differentiate ES from PNES, multivariate assessment models have superior discriminant power. The strongest psychometric evidence for PNES appears to be a consistent lack of impairment on tests sensitive to diffuse neurocognitive deficits such as processing speed, working memory, and verbal fluency. While video-electroencephalogram (EEG) monitoring is the gold standard of differential diagnosis, psychometric testing has the potential to enhance clinical decision-making, particularly in complex or unclear cases such as patients with nondiagnostic video-EEGs. Adopting a standardized, fixed neuropsychological battery at epilepsy centers would advance research on the differential diagnostic power of psychometric testing.
鉴别癫痫发作（ES）和精神性非癫痫发作（PNES）是一项具有挑战性的鉴别诊断，对治疗具有重要意义。本研究旨在探讨神经心理学测试分数在鉴别ES和PNES中的效用。
比较了72例ES患者和33例PNES患者在各种认知能力测试和效标效度测试中的心理测量数据。然后将最能区分诊断的个体测量指标作为预测变量纳入以组别（ES与PNES）为标准的逻辑回归方程。
在大多数认知能力测试中，PNES样本的表现优于ES样本（中到大效应量），且通过可靠数字广度测试的可能性较小。然而，PNES患者在两项嵌入式效度指标上未通过的比例显著更高（风险比（RR）：2.45 - 4.16）。在记忆伪装测试（TOMM）中，两组之间没有差异。基于七项神经心理学测试的逻辑回归方程正确分类了85.1%的患者。具有完美特异性的临界值对应的灵敏度为0.47。
与先前的研究一致，鉴别诊断的心理测量方法的效用受到与ES和PNES相关的复杂神经认知特征的限制。尽管个体测量指标可能有助于区分ES和PNES，但多变量评估模型具有更强的判别力。PNES最有力的心理测量证据似乎是在对诸如处理速度、工作记忆和语言流畅性等弥漫性神经认知缺陷敏感的测试中始终没有损伤。虽然视频脑电图（EEG）监测是鉴别诊断的金标准，但心理测量测试有可能加强临床决策，特别是在诸如视频脑电图无诊断意义的患者等复杂或不明确的病例中。在癫痫中心采用标准化、固定的神经心理学成套测试将推动关于心理测量测试鉴别诊断能力的研究。
