Departments of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut, 06520, USA.
Department of Neuroscience, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut, 06520, USA.
Ann Clin Transl Neurol. 2022 Jan;9(1):16-29. doi: 10.1002/acn3.51485. Epub 2022 Jan 11.
Clinicians rely on patient self-report of impairment during seizures for decisions including driving eligibility. However, the reliability of patient reports on cognitive and behavioral functions during seizures remains unknown.
We administered a daily questionnaire to epilepsy patients undergoing continuous video-EEG monitoring, asking about responsiveness, speech, memory, awareness, and consciousness during seizures in the preceding 24 hours. We also administered a questionnaire upon admission about responsiveness, speech, and awareness during seizures. Subjective questionnaire answers were compared with objective behavioral ratings on video review. Criteria for agreement were Cohen's kappa >0.60 and proportions of positive and negative agreement both >0.75.
We analyzed 86 epileptic seizures in 39 patients. Memory report on the daily questionnaire met criteria for agreement with video review (κ = 0.674 for early, 0.743 for late recall). Subjective report of awareness also met agreement criteria with video ratings of memory (κ = 0.673 early, 0.774 late). Concordance for speech was relatively good (κ = 0.679) but did not meet agreement criteria, nor did responsiveness or consciousness. On the admission questionnaire, agreement criteria were met for subjective report of awareness versus video ratings of memory (κ = 0.814 early, 0.806 late), but not for other comparisons.
Patient self-report of memory or awareness showed the best concordance with objective memory impairment during seizures. Self-report of impairment in other categories was less reliable. These findings suggest that patient reports about impaired memory during seizures may be most reliable, and otherwise determining functional impairments should be based on objective observations.
临床医生在做出包括驾驶资格在内的决策时，依赖于患者对发作期间受损情况的自我报告。然而，患者在发作期间对认知和行为功能的报告的可靠性尚不清楚。
我们对接受连续视频脑电图监测的癫痫患者进行了日常问卷调查，询问他们在过去 24 小时内发作期间的反应能力、言语、记忆、意识和清醒程度。我们还在入院时询问了他们在发作期间的反应能力、言语和意识情况。将主观问卷答案与视频回顾的客观行为评分进行比较。判断标准为 Cohen's kappa >0.60，阳性和阴性一致性的比例均>0.75。
我们分析了 39 名患者的 86 次癫痫发作。日常问卷中的记忆报告与视频回顾结果一致（早期回忆的 κ 值为 0.674，晚期回忆的 κ 值为 0.743）。主观的意识报告与记忆的视频评分也符合一致性标准（早期记忆的 κ 值为 0.673，晚期记忆的 κ 值为 0.774）。言语的一致性较好（κ 值为 0.679），但不符合一致性标准，反应能力和意识也不符合。入院时的问卷中，主观的意识报告与记忆的视频评分结果一致（早期记忆的 κ 值为 0.814，晚期记忆的 κ 值为 0.806），但其他比较结果不一致。
患者在发作期间对记忆或意识的自我报告与客观的记忆障碍具有最佳的一致性。其他类别的自我报告受损程度的可靠性较低。这些发现表明，患者在发作期间对记忆受损的报告可能最可靠，否则，应根据客观观察来确定功能障碍。
