Analyzing reliability of seizure diagnosis based on semiology
Analyzing reliability of seizure diagnosis based on semiology
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基于符号学的癫痫诊断可靠性分析
DOI：
10.1016/j.yebeh.2014.09.057
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发表时间：
2014-12-01
影响因子：
2.6
通讯作者：
Wang, Shuang
中科院分区：
文献类型：
--
作者：
Jin, Bo;Wu, Han;Wang, Shuang
本研究的目的是确定癫痫发作的诊断准确性的符号学分析和评估的因素，影响诊断的可靠性。由8名癫痫病学家、12名神经科医生和20名内科医生（内科医生）观察了50名患者（每名患者有3次相同类型的癫痫发作）的150个癫痫发作视频剪辑。这些视频包括37个系列的癫痫发作，8个系列的生理性非癫痫事件（PNEE），和5个系列的心因性非癫痫发作（PNES）。在观察每个视频后，医生为患者选择癫痫发作或非癫痫事件的诊断;如果选择后者，他们进一步选择PNES或PNEE的诊断。观察所有三次发作后，癫痫发作和非癫痫事件的总体诊断准确率从0.614增加到0.660（p < 0.001）。癫痫科医师诊断癫痫发作的敏感性和特异性分别为0.770和0.808。这些值显著高于神经科医生（0.660和0.699）和内科医生（0.588和0.658）。在各种癫痫发作类型中发现了广泛的诊断准确性。对全身强直阵挛性发作的诊断准确率最高，为0.895，其次是癫痫性发作，为0.800，自动性发作为0.760。肌阵挛性发作（0.530）、运动过度性发作（0.481）、痉挛性发作（0.438）和PNESS（0.430）的准确率较差。癫痫症状学诊断的可靠性受癫痫类型和医生经验的影响很大。虽然总体可靠性有限，但可以通过观察更多的癫痫发作来改善。(C)2014 Elsevier Inc. All rights reserved.
This study aimed to determine the accuracy of seizure diagnosis by semiological analysis and to assess the factors that affect diagnostic reliability. A total of 150 video clips of seizures from 50 patients (each with three seizures of the same type) were observed by eight epileptologists, 12 neurologists, and 20 physicians (internists). The videos included 37 series of epileptic seizures, eight series of physiologic nonepileptic events (PNEEs), and five series of psychogenic nonepileptic seizures (PNESs). After observing each video, the doctors chose the diagnosis of epileptic seizures or nonepileptic events for the patient; if the latter was chosen, they further chose the diagnosis of PNESs or PNEEs. The overall diagnostic accuracy rate for epileptic seizures and nonepileptic events increased from 0.614 to 0.660 after observations of all three seizures (p < 0.001). The diagnostic sensitivity and specificity of epileptic seizures were 0.770 and 0.808, respectively, for the epileptologists. These values were significantly higher than those for the neurologists (0.660 and 0.699) and physicians (0.588 and 0.658). A wide range of diagnostic accuracy was found across the various seizures types. An accuracy rate of 0.895 for generalized tonic-clonic seizures was the highest, followed by 0.800 for dialeptic seizures and then 0.760 for automotor seizures. The accuracy rates for myoclonic seizures (0.530), hypermotor seizures (0.481), gelastic/dacrystic seizures (0.438), and PNESs (0.430) were poor. The reliability of semiological diagnosis of seizures is greatly affected by the seizure type as well as the doctor's experience. Although the overall reliability is limited, it can be improved by observing more seizures. (C) 2014 Elsevier Inc. All rights reserved.