Avraham Linor, Spierer Ronen, Winer Raz, Bosak Noam, Wasserman Danielle, Herskovitz Moshe
Technion Faculty of Medicine, Haifa, Israel.
Neurology Department, Rambam Health Care Campus, Haifa, Israel.
Brain Behav. 2025 Jan;15(1):e70130. doi: 10.1002/brb3.70130.
Medical personnel show difficulty in differentiating psychogenic nonepileptic seizures (PNES) from epileptic seizures (ES). The purpose of this study was to conduct an initial feasibility assessment of the global dynamic impression (GDI) principle and to evaluate its effectiveness in enabling the diagnosis of epileptic versus psychogenic seizures using video footage of events, even by untrained personnel METHODS: We based this study on video footage showing five videos of PNES and five ES videos. We asked physicians and nurses from the emergency department, internal medicine department, neurology department, and medical students to classify the videos before and after learning the GDI principle. The GDI principle is a simple clinical tool assuming repetitive movements with minimal dynamics in vector and frequency in motor PNES. A correct answer earned a score of 10 points, and a wrong answer a score of 0. Therefore, the questionnaire score could range from 0 to 100.
A total of 108 medical personnel participated in the study. A total of 42 participants filled out the questionnaire before training-Group 1, and 36 participants filled out the questionnaire after training-Group 2; 30 participants filled out the questionnaire before and after the training-Group 3. The mean score of Group 1 was 55.23 ± 17.83 versus 75.55 ± 13.61 in Group 2 (p = 0.0000001). The mean score of Group 3 was 53 ± 17.8 compared to 78 ± 12.9, before and after training, respectively (p = 0.000001).
A brief training on the GDI principle of various medical teams, even unskilled teams, significantly improves differentiating PNES from ES.
医务人员难以区分精神性非癫痫性发作（PNES）和癫痫性发作（ES）。本研究的目的是对整体动态印象（GDI）原则进行初步可行性评估，并评估其在使用事件视频片段（即使是未经培训的人员）来诊断癫痫性发作与精神性发作方面的有效性。方法：我们基于展示5个PNES视频和5个ES视频的视频片段开展本研究。我们让急诊科、内科、神经科的医生和护士以及医学生在学习GDI原则之前和之后对视频进行分类。GDI原则是一种简单的临床工具，假定在运动性PNES中，向量和频率的动态变化极小的重复性动作。正确答案得10分，错误答案得0分。因此，问卷得分范围为0至100分。
共有108名医务人员参与了该研究。共有42名参与者在培训前填写了问卷——第1组，36名参与者在培训后填写了问卷——第2组；30名参与者在培训前后都填写了问卷——第3组。第1组的平均得分为55.23±17.83，而第2组为75.55±13.61（p = 0.0000001）。第3组在培训前和培训后的平均得分分别为53±17.8和78±12.9（p = 0.000001）。
对各个医疗团队（即使是不熟练的团队）进行关于GDI原则的简短培训，能显著提高区分PNES和ES的能力。
