Factors associated with delay to video-EEG in dissociative seizures.
Factors associated with delay to video-EEG in dissociative seizures.
复制标题
与分离性癫痫发作视频脑电图延迟相关的因素。
DOI：
10.1016/j.seizure.2021.02.018
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Stern JM
中科院分区：
文献类型：
--
作者：
Kerr WT;Zhang X;Hill CE;Janio EA;Chau AM;Braesch CT;Le JM;Hori JM;Patel AB;Allas CH;Karimi AH;Dubey I;Sreenivasan SS;Gallardo NL;Bauirjan J;Hwang ES;Davis EC;D'Ambrosio SR;Al Banna M;Cho AY;Dewar SR;Engel J Jr;Feusner JD;Stern JM
While certain clinical factors suggest a diagnosis of dissociative seizures (DS), otherwise known as functional or psychogenic nonepileptic seizures (PNES), ictal video-electroencephalography monitoring (VEM) is the gold standard for diagnosis. Diagnostic delays were associated with worse quality of life and more seizures, even after treatment. To understand why diagnoses were delayed, we evaluated which factors were associated with delay to VEM. Using data from 341 consecutive patients with VEM-documented dissociative seizures, we used multivariate log-normal regression with recursive feature elimination (RFE) and multiple imputation of some missing data to evaluate which of 76 clinical factors were associated with time from first dissociative seizure to VEM. The mean delay to VEM was 8.4 years (median 3 years, IQR 1–10 years). In the RFE multivariate model, the factors associated with longer delay to VEM included more past antiseizure medications (0.19 log-years/medication, standard error (SE) 0.05), more medications for other medical conditions (0.06 log-years/medication, SE 0.03), history of physical abuse (0.75 log-years, SE 0.27), and more seizure types (0.36 log-years/type, SE 0.11). Factors associated with shorter delay included active employment or student status (−1.05 log-years, SE 0.21) and higher seizure frequency (0.14 log-years/log[seizure/month], SE 0.06). Patients with greater medical and seizure complexity had longer delays. Delays in multiple domains of healthcare can be common for victims of physical abuse. Unemployed and non-student patients may have had more barriers to access VEM. These results support earlier referral of complex cases to a comprehensive epilepsy center.
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