Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.
Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Epilepsy Behav. 2021 Feb;115:107696. doi: 10.1016/j.yebeh.2020.107696. Epub 2021 Jan 1.
Descriptions of seizure manifestations (SM), or semiology, can help localize the symptomatogenic zone and subsequently included brain regions involved in epileptic seizures, as well as identify patients with dissociative seizures (DS). Patients and witnesses are not trained observers, so these descriptions may vary from expert review of seizure video recordings of seizures. To better understand how reported factors can help identify patients with DS or epileptic seizures (ES), we evaluated the associations between more than 30 SMs and diagnosis using standardized interviews.
Based on patient- and observer-reported data from 490 patients with diagnoses documented by video-electoencephalography, we compared the rate of each SM in five mutually exclusive groups: epileptic seizures (ES), DS, physiologic seizure-like events (PSLE), mixed DS and ES, and inconclusive testing.
In addition to SMs that we described in a prior manuscript, the following were associated with DS: light triggers, emotional stress trigger, pre-ictal and post-ictal headache, post-ictal muscle soreness, and ictal sensory symptoms. The following were associated with ES: triggered by missing medication, aura of déjà vu, and leftward eye deviation. There were numerous manifestations separately associated with mixed ES and DS.
Reported SM can help identify patients with DS, but no manifestation is pathognomonic for either ES or DS. Patients with mixed ES and DS reported factors divergent from both ES-alone and DS-alone.
发作表现（SM）或症状学的描述有助于定位症状发生区，并随后包括涉及癫痫发作的相关脑区，以及识别分离性发作（DS）患者。患者和目击者并非经过训练的观察者，因此这些描述可能与癫痫发作视频记录的专家审查有所不同。为了更好地理解报告的因素如何帮助识别 DS 或癫痫发作（ES）患者，我们使用标准化访谈评估了 30 多个 SM 与诊断之间的关联。
基于 490 名患者的患者和观察者报告的数据，这些患者的诊断通过视频-脑电图记录，我们比较了五个相互排斥的组中每种 SM 的发生率：癫痫发作（ES）、DS、生理性发作样事件（PSLE）、混合 DS 和 ES，以及不确定的测试。
除了我们在之前的一篇论文中描述的 SM 外，以下与 DS 相关：光触发、情绪压力触发、发作前和发作后头痛、发作后肌肉酸痛和发作时感觉症状。以下与 ES 相关：由漏药、似曾相识的预感和左眼偏斜触发。混合 ES 和 DS 患者分别有许多表现与 ES 和 DS 相关。
报告的 SM 有助于识别 DS 患者，但没有任何表现是 ES 或 DS 的特异性表现。混合 ES 和 DS 的患者报告的因素与 ES 或 DS 患者的因素不同。
