Abstract Details

Title Using Semiology to Classify Epileptic Seizures versus Psychogenic Non-Epileptic Seizures - A Meta-Analysis

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 145

Objective To evaluate the diagnostic accuracy of semiology in psychogenic nonepileptic seizures and epileptic seizures.

Background Misdiagnosis of PNES and ES is common. In the absence of video EEG, clinicians rely on semiology and clinical assessment. However, questions regarding the diagnostic accuracy of different signs remain.

Design/Methods A systematic search of Medline, PubMed and PsycInfo was performed from inception to February 2021 to identify studies that compared semiology in ES and PNES in epilepsy monitoring units. Non-English publications, review articles, studies reporting on only PNES or ES and studies limited to patients with developmental delay were excluded. Study characteristics and proportions of ‘event groups’ and ‘patient groups’ demonstrating signs were extracted from each article. Bivariate analysis was conducted, and data were pooled in a random effects model for meta-analysis. The I² statistic was calculated to assess statistical heterogeneity. The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were calculated. A PLR > 10 or an NLR < 0.1 has a large impact on the post-test probability of a diagnosis whereas a PLR between 5-10 or an NLR between 0.1- 0.2 has a moderate impact on the post-test probability of a diagnosis.

Results There were 14 studies comprising of 800 patients with ES and 452 patients with PNES. For PNES, ictal eye closure (PLR 40.5 95%CI: 16.2-101.3; I² = 0, from three studies) and asynchronous limb movements (PLR 10.2; 95%CI: 2.8-37.7; I² = 0, from three studies) reached a PLR threshold > 5. No single sign reached a PLR threshold >5 for ES. The overall GRADE score for the evidence evaluating ictal eye closure and asynchronous limb movements as a predictor for PNES were high and moderate respectively.

Conclusions While all signs require interpretation in the overall clinical context, the presence of ictal eye closure and asynchronous limb movements are reliable discriminative signs for PNES.

Authors/Disclosures
Subramanian Muthusamy, MBBS (MMC) PRESENTER	Dr. Muthusamy has nothing to disclose.
Udaya K. Seneviratne, MD (Monash Medical Centre)	Dr. Seneviratne has nothing to disclose.
Catherine T. Ding, MD (Monash Medical Centre)	Dr. Ding has nothing to disclose.
Thanh Phan, MD (Mayo Clinic)	Dr. Phan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bayer.

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