Neurology Department, Hopital Avicenne, Assistance Publique, Hôpitaux de Paris, Paris, France.
Epileptology Unit, Reference Center for Rare Epilepsies, Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.
Eur J Neurol. 2024 Oct;31(10):e16430. doi: 10.1111/ene.16430. Epub 2024 Aug 3.
Prior studies highlighted the high diagnostic specificity (ranging from 92% to 100%) of clinical signs observed in functional neurological disorders (FNDs). However, these signs are rarely looked for by epileptologists when trying to distinguish between functional dissociative seizure (FDS) and epileptic seizure. The aim of this study was to determine the prevalence of inter-ictal clinical signs of FND in a cohort of patients with probable FDS. The secondary objective was to compare the prevalence of inter-ictal FND clinical signs in FDS patients with age- and gender-matched epileptic patients without FDS.
Patients diagnosed with FDS seen at two tertiary care centres and epileptic outpatients were included in the study. Each patient underwent a physical examination, searching for inter-ictal clinical signs of FND.
In the FDS group, 79% of patients presented at least one sign of FND, compared to 16.6% of patients with epilepsy (p < 0.001). Moreover, 66.6% of FDS patients presented three or more FND signs, whereas only 4.1% of epileptic patients did (p < 0.001). The median number of FND clinical signs in the FDS group was four (SD 1.7; 5.5). Using the threshold of three signs or more, the specificity of detecting three or more FND signs was 83.3%, with a sensitivity of 79.2%.
Inter-ictal clinical signs of FND are present in patients with FDS and should be looked for during neurological examination.
先前的研究强调了功能性神经障碍（FND）中观察到的临床体征具有很高的诊断特异性（范围为 92%至 100%）。然而，当癫痫学家试图区分功能性分离性发作（FDS）和癫痫发作时，很少会寻找这些体征。本研究旨在确定可能患有 FDS 的患者群体中 FND 发作间期临床体征的患病率。次要目的是比较 FDS 患者与年龄和性别匹配的无 FDS 癫痫患者之间 FDS 发作间期 FND 临床体征的患病率。
研究纳入了在两个三级护理中心就诊的 FDS 患者和癫痫门诊患者。每位患者均接受体格检查，寻找 FND 的发作间期临床体征。
在 FDS 组中，79%的患者至少出现一种 FND 体征，而癫痫组患者为 16.6%（p<0.001）。此外，66.6%的 FDS 患者出现了 3 种或更多的 FND 体征，而只有 4.1%的癫痫患者出现了这种情况（p<0.001）。FDS 组 FND 临床体征的中位数为 4 个（SD 1.7；5.5）。使用 3 个或更多体征的阈值，检测 3 个或更多 FND 体征的特异性为 83.3%，敏感性为 79.2%。
FDS 患者存在 FND 的发作间期临床体征，在神经学检查中应寻找这些体征。
