Department of Clinical Neurosciences, St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia.
Department of Neurology, Monash Medical Centre, Melbourne, VIC, Australia.
J Neurol. 2022 Apr;269(4):2172-2178. doi: 10.1007/s00415-021-10805-1. Epub 2021 Sep 22.
The diagnosis of psychogenic nonepileptic seizures (PNES) is a common clinical dilemma. We sought to assess the diagnostic value of four ictal signs commonly used in differentiating PNES from epileptic seizures (ES).
We retrospectively reviewed consecutive adult video-electroencephalogram (VEM) studies conducted at a single tertiary epilepsy center between May 2009 and August 2016. Each event was assessed by a blinded rater for the presence of four signs: fluctuating course, head shaking, hip thrusting, and back arching. The final diagnosis of PNES or ES was established for each event based on clinical and VEM characteristics. All ES were pooled regardless of focal or generalized onset. We analyzed the odds ratio of each sign in PNES in comparison to ES with adjustment for repeated measures using logistic regression. Additionally, we calculated the sensitivity, specificity, predictive values, and likelihood ratios of each sign to diagnose PNES.
A total of 742 events from 140 VEM studies were assessed. Fluctuating course (odds ratio (OR) 37.37, 95% confidence interval (CI) 13.56-102.96, P < 0.0001), head shaking (OR 2.95, 95% CI 1.26-6.79, P = 0.012), and hip thrusting (OR 4.28, 95% CI 1.21-15.18, P = 0.02) were each significantly predictive of PNES. Fluctuating course had the highest sensitivity (76.16%). Back arching (OR 1.06, 95% CI 0.35-3.20, P = 0.92) was not significantly associated with PNES.
Fluctuating course, head shaking, and hip thrusting are semiological features significantly more common in PNES than ES. Fluctuating course is the most reliable sign. Back arching does not appear to differentiate PNES from ES.
心因性非癫痫性发作（PNES）的诊断是临床常见的难题。我们旨在评估四种常用于鉴别 PNES 与癫痫发作（ES）的发作期体征的诊断价值。
我们回顾性分析了 2009 年 5 月至 2016 年 8 月在单中心三级癫痫中心进行的连续成人视频脑电图（VEM）研究。由盲法评分者评估每个事件是否存在以下 4 种体征：波动病程、摇头、髋关节前冲和背部弓起。根据临床和 VEM 特征，为每个事件确定 PNES 或 ES 的最终诊断。所有 ES 均被汇总，无论局灶性或全面性发作。我们使用逻辑回归分析，在重复测量的情况下，对每个体征在 PNES 中的比值比进行调整，以分析其比值比。此外，我们计算了每个体征诊断 PNES 的敏感性、特异性、预测值和似然比。
共评估了 140 项 VEM 研究的 742 项事件。波动病程（比值比（OR）37.37，95%置信区间（CI）13.56-102.96，P<0.0001）、摇头（OR 2.95，95%CI 1.26-6.79，P=0.012）和髋关节前冲（OR 4.28，95%CI 1.21-15.18，P=0.02）均与 PNES 显著相关。波动病程的敏感性最高（76.16%）。背部弓起（OR 1.06，95%CI 0.35-3.20，P=0.92）与 PNES 无显著相关性。
波动病程、摇头和髋关节前冲是 PNES 比 ES 更常见的半定性特征。波动病程是最可靠的体征。背部弓起似乎不能区分 PNES 和 ES。
