‘Positive’ inter-ictal clinical signs of functional neurological disorders are found in patients with functional dissociative seizures

IF 4.5 2区医学 Q1 CLINICAL NEUROLOGY

European Journal of Neurology Pub Date : 2024-08-03 DOI:10.1111/ene.16430

Margaux Cheval, Arnaud Lapostolle, Astrid De Liège, Louise Tyvaert, Charlotte Joly, Béatrice Garcin

{"title":"‘Positive’ inter-ictal clinical signs of functional neurological disorders are found in patients with functional dissociative seizures","authors":"Margaux Cheval, Arnaud Lapostolle, Astrid De Liège, Louise Tyvaert, Charlotte Joly, Béatrice Garcin","doi":"10.1111/ene.16430","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background and purpose</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>In the FDS group, 79% of patients presented at least one sign of FND, compared to 16.6% of patients with epilepsy (<i>p</i> < 0.001). Moreover, 66.6% of FDS patients presented three or more FND signs, whereas only 4.1% of epileptic patients did (<i>p</i> < 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%.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Inter-ictal clinical signs of FND are present in patients with FDS and should be looked for during neurological examination.</p>\n </section>\n </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":null,"pages":null},"PeriodicalIF":4.5000,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.16430","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Neurology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/ene.16430","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background and purpose

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.

Methods

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.

Results

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%.

Conclusion

Inter-ictal clinical signs of FND are present in patients with FDS and should be looked for during neurological examination.

Abstract Image

查看原文本刊更多论文

功能性分离性癫痫发作患者发作间期会出现功能性神经紊乱的 "阳性 "临床症状。

背景和目的：先前的研究强调，在功能性神经紊乱（FND）中观察到的临床症状具有很高的诊断特异性（从 92% 到 100% 不等）。然而，癫痫专家在试图区分功能性分离性发作（FDS）和癫痫发作时却很少注意到这些体征。本研究旨在确定一组可能患有 FDS 的患者中 FND 发作间期临床症状的流行率。次要目的是比较 FDS 患者与无 FDS 的年龄和性别匹配的癫痫患者发作间期 FND 临床症状的发生率：研究对象包括在两家三级医疗中心就诊的 FDS 患者和癫痫门诊患者。每位患者都接受了体格检查，寻找发作间期 FND 的临床表现：结果：在 FDS 组中，79% 的患者至少有一种 FND 征象，而癫痫患者中只有 16.6% 有此征象（P，结论：FND 的发作间期临床征象与癫痫的发作间期临床征象相似）：FDS患者存在FND发作间期临床表现，应在神经系统检查时加以注意。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

European Journal of Neurology 医学-临床神经学

CiteScore

9.70

自引率

2.00%

发文量

418

审稿时长

1 months

期刊介绍： The European Journal of Neurology is the official journal of the European Academy of Neurology and covers all areas of clinical and basic research in neurology, including pre-clinical research of immediate translational value for new potential treatments. Emphasis is placed on major diseases of large clinical and socio-economic importance (dementia, stroke, epilepsy, headache, multiple sclerosis, movement disorders, and infectious diseases).