Department of Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, Australia.
The Epilepsy Unit, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia.
Epilepsy Behav. 2020 Nov;112:107482. doi: 10.1016/j.yebeh.2020.107482. Epub 2020 Sep 28.
Epilepsy and psychogenic nonepileptic seizures (PNES) are serious conditions, associated with substantial morbidity and mortality. Although prompt diagnosis is essential, these conditions are frequently misdiagnosed, delaying appropriate treatment. We developed and validated the Anxiety, Abuse, and Somatization Questionnaire (AASQ), a quick and clinically practical tool to differentiate PNES from epilepsy.
We retrospectively identified psychological variables that differentiated epilepsy from PNES in a discovery cohort of patients admitted to a video-electroencephalography monitoring (VEM) unit from 2002 to 2017. From these findings, we developed the AASQ and prospectively validated it in an independent cohort of patients with gold-standard VEM diagnosis.
One thousand two hundred ninety-one patients were included in the retrospective study; mean age was 39.5 years (range: 18-99), 58% were female, 67% had epilepsy, and 33% had PNES. Psychometric data for 192 instrument items were reviewed, receiver operating characteristic curves were computed, and a 20-item AASQ was created. Prospective validation in 74 patients showed that a one-point increase in the AASQ score was associated with 11 times increase in the odds of having PNES compared with epilepsy. Low scores on the AASQ were associated with a low probability of PNES with a negative predictive value of 95%.
The AASQ is quick, inexpensive, and clinically useful for workup of seizure disorders. The AASQ excludes PNES with a high degree of confidence and can predict PNES with significance when combined with basic clinicodemographic variables. Future research will investigate diagnostic performance of the AASQ in relevant clinical subgroups, such as patients with comorbid epilepsy and PNES.
癫痫和心因性非癫痫性发作（PNES）是严重的疾病，与较高的发病率和死亡率相关。尽管及时诊断至关重要，但这些疾病经常被误诊，导致治疗延迟。我们开发并验证了焦虑、滥用和躯体化问卷（AASQ），这是一种快速且临床实用的工具，可将 PNES 与癫痫区分开来。
我们回顾性地确定了在 2002 年至 2017 年间因癫痫入组视频脑电图监测（VEM）单元的患者的发现队列中区分癫痫与 PNES 的心理变量。根据这些发现，我们开发了 AASQ，并在具有 VEM 金标准诊断的独立患者队列中进行了前瞻性验证。
共有 1291 例患者纳入了回顾性研究；平均年龄为 39.5 岁（范围：18-99），58%为女性，67%患有癫痫，33%患有 PNES。对 192 个仪器项目的心理测量数据进行了审查，计算了受试者工作特征曲线，并创建了一个 20 项 AASQ。对 74 例患者进行的前瞻性验证表明，AASQ 评分增加 1 分与 PNES 的可能性增加 11 倍相关，而不是癫痫。AASQ 得分较低与 PNES 的可能性较低相关，阴性预测值为 95%。
AASQ 快速、廉价且在癫痫疾病的检查中具有临床实用性。AASQ 可以高度置信地排除 PNES，并与基本临床和人口统计学变量相结合时，可以预测 PNES 的发生。未来的研究将调查 AASQ 在相关临床亚组中的诊断性能，例如患有共患癫痫和 PNES 的患者。
