Methodologic Validity Of Patient's History In Establishing The Diagnosis Of Epileptic Attacks

Abstract

-

Keywords

• -

Methodologic Validity Of Patient's History In Establishing The Diagnosis Of Epileptic Attacks

Abstract

Aim: We tried to determine the specificity and sensitivity of history in the diagnosis of epileptic seizures in outpatient clinics specialised on epilepsy. Methods: Three-hundred and twelve patients presented with a complaint of fit or fainting were evaluated. Ninety seven patients (40 males, 57 females) with a mean age of 27.89±17.19 years in neurology outpatient clinics were included in Group I and 215 patients (125 males, 87 women) with a mean age of 24.97±15.50 years in outpatient clinics specialized on epilepsy were included in Group II. Initial diagnoses were compared with definitive diagnoses reached through detailed investigations. The methodological validity of history in leading to definitive diagnosis was sought and compared in each group. Results: The most frequent epileptic and non-epileptic seizures were generalized tonic-clonic and psychogenic seizures respectively. The most common ictal finding was unresponsiveness in both types. The sensitivity and specificity of history in the diagnosis of epileptic seizures were 65.8% and 64.1%, respectively in Group I. The ninety-nine percentage (sensitivity) of epileptic and 57.1% (selectivity) of nonepileptic cases were diagnosed with medical history in Group II. Conclusion: The initial diagnosis of epileptic seizures can be improved by a more carefully history taking, by administering a seizure-questionnaire, and by evaluating patients at a more specialized outpatient clinic circumstances

Keywords

• Conversion disorder, epilepsy, psychophysiologic disorders, seizures

References

1. Chabolla DR, Krahn LE, So EL, Rummans TA. Psychogenic nonepileptic seizures. Mayo Clin Proc 1996;71:493-500
2. Rowan AJ. Nonepileptic seizures. In: Schachter SC, Schomer DL, eds. The Comprehensive Evaluation and Treatment of Epilepsy. Academic Press 1997:173-83
3. Malmgren K, Blennow G, Hedstrom A. Differential diagnosis in epilepsy. Anamnesis is still the most important guide. Lakartidningen 1997;94:1985-90 [Abstract]
4. Eroğlu E, Gökçil Z, Ulaş H. The problems with epilepsy diagnosis.Gülhane Medical Journal 2000;42:378-82
5. Nowack WJ. Epilepsy: a costly misdiagnosis. Clin Electroencephalogr 1997;28:225-8
6. Leis AA, Ross MA, Summers AK. Psychogenic seizures: ictal characteristics and diagnostic pitfalls. Neurology 1992;42:95-9
7. Devinsky O, Sanchez-Villasenor F, Vazquez B, Kothari M, Alper K, Luciano D. Clinical profile of patients with epileptic and nonepileptic seizures. Neurology 1996;46:1530-3
8. Hoefnagels WA, Padberg GW, Overweg J, Roos RA, van Dijk JG, Kamphuisen HA. Syncope or seizure? The diagnostic value of the EEG and hyperventilation test in transient loss of consciousness. J Neurol Neurosurg Psychiatry 1991;54:953-6

9. Theodore WH, Porter RJ, Albert P, et al. The secondarily generalized tonic-clonic seizure: a videotape analysis. Neurology 1994;44:1403-7
10. McDade G, Brown SW. Non-epileptic seizures: management and predictive factors of outcome. Seizure 1992;1:7-10
11. Özkara Ç, Dreifuss FE. Differential diagnosis in pseudoepileptic seizures. Epilepsia 1993;34:294-8
12. Alper K, Devinsky O, Perrine K, Vazquez B, Luciano D. Psychiatric classification of nonconversion nonepileptic seizures. Arch Neurol 1995;52:199-201
13. Brown P. Myoclonus. In: Sawle G, ed. Movement disorders in clinical practice. Oxford: Isis Medical Media; 1999, p:147-56
14. Saygı S, Katz A, Marks DA, Spencer SS. Frontal lobe partial seizures and psychogenic of clinical and ictal characteristics. Neurology 1992;42:1274-7 comparison RP. Psychogenic seizures. Neurology 1996; 46:1499-507
15. Gates JR, Ramani V, Whalen S, Loewenson R. Ictal characteristics of pseudoseizures. Arch Neurol 1985;42: 1183-7
16. Betts T, Boden S. Diagnosis, management and prognosis of a group of 128 patients with non-epileptic attack disorder. Part I. Seizure 1992;1:19-26
17. Sperling MR, Pritchard PB 3rd, Engel J Jr, Daniel C,Sagel J. Prolactin in partial epilepsy: an indicator of limbic seizures. Ann Neurol 1986;20:716-22
18. Yerby MS, van Belle G, Friel PN, Wilensky AJ.Serum prolactins in the diagnosis of epilepsy: sensitivity,specificity, and predictive value. Neurology 1987;37: 1224-6
19. Walczak TS, Williams DT, Berten W. Utility and reliability of placebo infusion in the evaluation of patients with seizures. Neurology 1994;44:394-9
20. Togay-Işıkay C, Yiğit A, Öncü B. The reliability of anamnesis in distinguishing between psychogenic seizures. Epilepsi (Journal of Turkish Epileptic Society) 1999;5:70-4
21. Volow MR. Pseudoseizures: an overview. South Med J 1986;79:600-7
22. Boon PA, Williamson PD. The diagnosis of pseudoseizures.Clin Neurol Neurosurg 1993;95:1-8