Diagnostic features of functional/ dissociative seizures in the first presentation of transient loss of consciousness

IF 2.3 3区医学 Q2 BEHAVIORAL SCIENCES

Epilepsy & Behavior Pub Date : 2025-01-16 DOI:10.1016/j.yebeh.2025.110263

Alistair Wardrope , Stephen J Howell , Markus Reuber

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引用次数: 0

Abstract

Objectives

Previous studies have identified features in patient’s history and seizure descriptions supporting a clinical diagnosis of functional / dissociative seizures (FDS). However, most studies involved patients with chronic seizure disorders. This study explores the value of reported features for a clinical diagnosis of FDS in an adult population with a first presentation of transient loss of consciousness (TLoC).

Methods

We prospectively recruited patients newly presenting with TLoC to an Emergency Department (ED), Acute Medical Unit (AMU; admitting ward for general medical patients), first seizure or syncope clinic. We invited participants to complete an online questionnaire, either at home or at time of initial assessment. Two expert raters determined cause of participants’ TLOC after 6-month follow-up. We also reviewed clinical records at this timepoint to extract relevant information for assessment of putative diagnostic features (13 categorical variables and 6 interval or continuous variables), and validation of two previously-developed diagnostic classifiers.

Results

We included 178 patients in final analysis (134 syncope, 32 epilepsy, 12 FDS). 3 categorical variables were significantly more common in FDS: fluctuating course or waxing/waning movements (p = 0.0037), asynchronous limb movements (p = 0.0024), and preserved ictal awareness or responsiveness (p = 0.0013). Three interval/continuous variables supported diagnosis of FDS: younger age at onset (area under receiver-operating characteristic curve [AUC] = 0.865 (0.771–0.960)); total non-ictal symptoms reported on structured review of systems (AUC = 0.834 (0.730–0.928)); and total peri-ictal symptoms self-reported on structured questionnaire (AUC = 0.864 (0.781–0.948)).

Conclusions

Our study does not find support for some clinical features previously reported as diagnostic of FDS in adult patients with a first presentation of TLoC. Features suggestive of preserved ictal responsiveness (reported by witnesses) and awareness (in the form of total number of self-reported peri-ictal symptoms) support FDS diagnoses.

查看原文本刊更多论文

以短暂性意识丧失为首发表现的功能性/解离性癫痫的诊断特征。

目的：先前的研究已经确定了患者病史和癫痫发作描述的特征，支持功能性/解离性癫痫发作（FDS）的临床诊断。然而，大多数研究涉及的是慢性癫痫患者。本研究探讨了首次表现为一过性意识丧失（TLoC）的成年人群中FDS的临床诊断的报道特征的价值。方法：我们前瞻性地招募新出现TLoC的患者到急诊科（ED），急症室（AMU）；住院病房（普通内科病人），首次发作或晕厥门诊。我们邀请参与者在家中或在初始评估时完成一份在线问卷。经过6个月的随访，由两名专家评估师确定了参与者TLOC的原因。我们还回顾了该时间点的临床记录，以提取评估推定诊断特征（13个分类变量和6个区间或连续变量）的相关信息，并验证了先前开发的两种诊断分类器。结果：最终纳入178例患者，其中晕厥134例，癫痫32例，FDS 12例。3个分类变量在FDS中更为常见：波动过程或起伏/减弱运动（p = 0.0037），非同步肢体运动（p = 0.0024），以及保留的直立意识或反应（p = 0.0013）。三个区间/连续变量支持FDS的诊断：发病年龄较轻（受者-工作特征曲线下面积[AUC] = 0.865 (0.771-0.960)）；系统结构化评价报告的总非症状（AUC = 0.834 (0.730-0.928)）；以结构化问卷自述总牙周症状（AUC = 0.864(0.781-0.948)）。结论：我们的研究没有发现先前报道的一些临床特征支持首次出现TLoC的成年患者诊断FDS。提示保留的月经期反应性（由证人报告）和意识（以自我报告的月经周症状总数的形式）的特征支持FDS诊断。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Epilepsy & Behavior 医学-行为科学

CiteScore

5.40

自引率

15.40%

发文量

385

审稿时长

43 days

期刊介绍： Epilepsy & Behavior is the fastest-growing international journal uniquely devoted to the rapid dissemination of the most current information available on the behavioral aspects of seizures and epilepsy. Epilepsy & Behavior presents original peer-reviewed articles based on laboratory and clinical research. Topics are drawn from a variety of fields, including clinical neurology, neurosurgery, neuropsychiatry, neuropsychology, neurophysiology, neuropharmacology, and neuroimaging. From September 2012 Epilepsy & Behavior stopped accepting Case Reports for publication in the journal. From this date authors who submit to Epilepsy & Behavior will be offered a transfer or asked to resubmit their Case Reports to its new sister journal, Epilepsy & Behavior Case Reports.