The EpiLing-Tool: A new tool to distinguish epileptic seizures from dissociative seizures in the first encounter between physician and patient

Purpose

Studies have shown that conversation analysis of doctor-patient-encounters can help with the distinction of accounts of epileptic seizures (ES) and dissociative seizures (DS). We were keen to make these linguistic insights available to clinicians.

Methods

We analyzed 80 doctor-patient-encounters with young seizure patients (aged 6.1 to 17.9 years, mean 13.9 years). The conversations followed a guideline highlighting the importance of open invitations for patients to talk.

Based on previous studies, we created the EpiLing-Tool: a scoring-table with two sets of eight items – either favoring a diagnosis of ES or DS. The items focus on how patients describe the seizures, on their attitude towards the seizures, seizure interruption strategies and the course of the conversation.

In two one-day-training sessions clinicians blinded to the medical diagnosis used the EpiLing-Tool on recordings of patient interviews. In one session 50 participants rated eleven recordings, in the other session 25 participants rated ten different recordings.

Results

A mean of 30.8 EpiLing-Tools (range 9 to 49) were completed for every recording. In the eight patients with DS, the correct diagnostic conclusion was documented in 206 of 237 ratings using the EpiLing-Tool (sensitivity 86.9 %). In the ES group, the correct diagnosis was identified in 364 of 409 ratings (sensitivity 89.0 %); the sensitivity of the tool did not differ between the five patients with focal ES (sensitivity 88.6 %), and the eight patients with generalized ES (sensitivity 89.2 %).

Conclusions

The EpiLing-Tool is a simple and promising scoring table that can help clinicians to recognize DS when they first take the history of children and adolescents with seizures.