Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States.
Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.
Seizure. 2021 Mar;86:116-122. doi: 10.1016/j.seizure.2021.02.002. Epub 2021 Feb 9.
Video-electroencephalographic monitoring (VEM) is a core component to the diagnosis and evaluation of epilepsy and dissociative seizures (DS)-also known as functional or psychogenic seizures-but VEM evaluation often occurs later than recommended. To understand why delays occur, we compared how patient-reported clinical factors were associated with time from first seizure to VEM (TVEM) in patients with epilepsy, DS or mixed.
We acquired data from 1245 consecutive patients with epilepsy, VEM-documented DS or mixed epilepsy and DS. We used multivariate log-normal regression with recursive feature elimination (RFE) to evaluate which of 76 clinical factors interacting with patients' diagnoses were associated with TVEM.
The mean and median TVEM were 14.6 years and 10 years, respectively (IQR 3-23 years). In the multivariate RFE model, the factors associated with longer TVEM in all patients included unemployment and not student status, more antiseizure medications (current and past), concussion, and ictal behavior suggestive of temporal lobe epilepsy. Average TVEM was shorter for DS than epilepsy, particularly for patients with depression, anxiety, migraines, and eye closure. Average TVEM was longer specifically for patients with DS taking more medications, more seizure types, non-metastatic cancer, and with other psychiatric comorbidities.
In all patients with seizures, trials of numerous antiseizure medications, unemployment and non-student status was associated with longer TVEM. These associations highlight a disconnect between International League Against Epilepsy practice parameters and observed referral patterns in epilepsy. In patients with dissociative seizures, some but not all factors classically associated with DS reduced TVEM.
视频脑电图监测（VEM）是癫痫和分离性发作（DS）——也称为功能性或心因性发作——诊断和评估的核心组成部分，但 VEM 评估往往晚于推荐时间。为了了解为什么会出现延迟，我们比较了患者报告的临床因素与癫痫、DS 或混合性患者首次发作至 VEM（TVEM）的时间之间的关系。
我们从 1245 例连续癫痫患者、有 VEM 记录的 DS 或混合性癫痫和 DS 患者中获取数据。我们使用带有递归特征消除（RFE）的多元对数正态回归来评估与 TVEM 相关的 76 个临床因素与患者诊断的相互作用。
平均和中位数 TVEM 分别为 14.6 年和 10 年（IQR 3-23 年）。在多元 RFE 模型中，所有患者中与 TVEM 较长相关的因素包括失业和非学生身份、更多的抗癫痫药物（目前和过去）、脑震荡和提示颞叶癫痫的发作行为。与癫痫相比，DS 的平均 TVEM 更短，特别是对于患有抑郁、焦虑、偏头痛和闭眼的患者。DS 患者服用更多药物、更多发作类型、非转移性癌症和其他精神共病的平均 TVEM 更长。
在所有有发作的患者中，尝试多种抗癫痫药物、失业和非学生身份与 TVEM 较长有关。这些关联突出了国际抗癫痫联盟实践参数与癫痫观察到的转诊模式之间的脱节。在分离性发作患者中，一些但不是所有与 DS 相关的经典因素会缩短 TVEM。
