Evidence map›Paper›PMID 27385741›Full record

ArticleNeurology2016

Value of patient-reported symptoms in the diagnosis of transient loss of consciousness.

Markus Reuber, Min Chen, Jenny Jamnadas-Khoda, Mark Broadhurst, Melanie Wall, Richard A Grünewald, Stephen J Howell, Matthias Koepp, Steve Parry, Sanjay Sisodiya and 2 more

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In one paragraph

Article in Neurology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 23 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

23 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Seizures as the first clinical manifestation of acute pulmonary embolism: an underestimate issue in neurocritical care.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2020
    Pooled it
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  11. The hermeneutics of symptoms.Medicine, health care, and philosophy · 2022
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors.

Markus ReuberFrom the Academic Neurology Unit (M.R., J.J.-K.), Royal Hallamshire Hospital, University of Sheffield, UK; Gertrude H. Sergievsky Center (M.C., M. Wall, D.H.), Columbia University, New York, NY; Mental Health Liaison Team (M.B.), Derbyshire Healthcare NHS Foundation Trust Hartington Unit, Chesterfield; Department of Neurology (R.A.G., S.J.H.), Sheffield Teaching Hospitals NHS Foundation Trust; Department of Clinical and Experimental Epilepsy (M.K., S.S., M. Walker), University College London, Institute of Neurology; and Institute of Cellular Medicine (S.P.), Newcastle University, UK. m.reuber@sheffield.ac.uk.
Min ChenFrom the Academic Neurology Unit (M.R., J.J.-K.), Royal Hallamshire Hospital, University of Sheffield, UK; Gertrude H. Sergievsky Center (M.C., M. Wall, D.H.), Columbia University, New York, NY; Mental Health Liaison Team (M.B.), Derbyshire Healthcare NHS Foundation Trust Hartington Unit, Chesterfield; Department of Neurology (R.A.G., S.J.H.), Sheffield Teaching Hospitals NHS Foundation Trust; Department of Clinical and Experimental Epilepsy (M.K., S.S., M. Walker), University College London, Institute of Neurology; and Institute of Cellular Medicine (S.P.), Newcastle University, UK.
Jenny Jamnadas-KhodaFrom the Academic Neurology Unit (M.R., J.J.-K.), Royal Hallamshire Hospital, University of Sheffield, UK; Gertrude H. Sergievsky Center (M.C., M. Wall, D.H.), Columbia University, New York, NY; Mental Health Liaison Team (M.B.), Derbyshire Healthcare NHS Foundation Trust Hartington Unit, Chesterfield; Department of Neurology (R.A.G., S.J.H.), Sheffield Teaching Hospitals NHS Foundation Trust; Department of Clinical and Experimental Epilepsy (M.K., S.S., M. Walker), University College London, Institute of Neurology; and Institute of Cellular Medicine (S.P.), Newcastle University, UK.
Mark BroadhurstFrom the Academic Neurology Unit (M.R., J.J.-K.), Royal Hallamshire Hospital, University of Sheffield, UK; Gertrude H. Sergievsky Center (M.C., M. Wall, D.H.), Columbia University, New York, NY; Mental Health Liaison Team (M.B.), Derbyshire Healthcare NHS Foundation Trust Hartington Unit, Chesterfield; Department of Neurology (R.A.G., S.J.H.), Sheffield Teaching Hospitals NHS Foundation Trust; Department of Clinical and Experimental Epilepsy (M.K., S.S., M. Walker), University College London, Institute of Neurology; and Institute of Cellular Medicine (S.P.), Newcastle University, UK.
Melanie WallFrom the Academic Neurology Unit (M.R., J.J.-K.), Royal Hallamshire Hospital, University of Sheffield, UK; Gertrude H. Sergievsky Center (M.C., M. Wall, D.H.), Columbia University, New York, NY; Mental Health Liaison Team (M.B.), Derbyshire Healthcare NHS Foundation Trust Hartington Unit, Chesterfield; Department of Neurology (R.A.G., S.J.H.), Sheffield Teaching Hospitals NHS Foundation Trust; Department of Clinical and Experimental Epilepsy (M.K., S.S., M. Walker), University College London, Institute of Neurology; and Institute of Cellular Medicine (S.P.), Newcastle University, UK.
Richard A GrünewaldFrom the Academic Neurology Unit (M.R., J.J.-K.), Royal Hallamshire Hospital, University of Sheffield, UK; Gertrude H. Sergievsky Center (M.C., M. Wall, D.H.), Columbia University, New York, NY; Mental Health Liaison Team (M.B.), Derbyshire Healthcare NHS Foundation Trust Hartington Unit, Chesterfield; Department of Neurology (R.A.G., S.J.H.), Sheffield Teaching Hospitals NHS Foundation Trust; Department of Clinical and Experimental Epilepsy (M.K., S.S., M. Walker), University College London, Institute of Neurology; and Institute of Cellular Medicine (S.P.), Newcastle University, UK.
Stephen J HowellFrom the Academic Neurology Unit (M.R., J.J.-K.), Royal Hallamshire Hospital, University of Sheffield, UK; Gertrude H. Sergievsky Center (M.C., M. Wall, D.H.), Columbia University, New York, NY; Mental Health Liaison Team (M.B.), Derbyshire Healthcare NHS Foundation Trust Hartington Unit, Chesterfield; Department of Neurology (R.A.G., S.J.H.), Sheffield Teaching Hospitals NHS Foundation Trust; Department of Clinical and Experimental Epilepsy (M.K., S.S., M. Walker), University College London, Institute of Neurology; and Institute of Cellular Medicine (S.P.), Newcastle University, UK.
Matthias KoeppFrom the Academic Neurology Unit (M.R., J.J.-K.), Royal Hallamshire Hospital, University of Sheffield, UK; Gertrude H. Sergievsky Center (M.C., M. Wall, D.H.), Columbia University, New York, NY; Mental Health Liaison Team (M.B.), Derbyshire Healthcare NHS Foundation Trust Hartington Unit, Chesterfield; Department of Neurology (R.A.G., S.J.H.), Sheffield Teaching Hospitals NHS Foundation Trust; Department of Clinical and Experimental Epilepsy (M.K., S.S., M. Walker), University College London, Institute of Neurology; and Institute of Cellular Medicine (S.P.), Newcastle University, UK.
Steve ParryFrom the Academic Neurology Unit (M.R., J.J.-K.), Royal Hallamshire Hospital, University of Sheffield, UK; Gertrude H. Sergievsky Center (M.C., M. Wall, D.H.), Columbia University, New York, NY; Mental Health Liaison Team (M.B.), Derbyshire Healthcare NHS Foundation Trust Hartington Unit, Chesterfield; Department of Neurology (R.A.G., S.J.H.), Sheffield Teaching Hospitals NHS Foundation Trust; Department of Clinical and Experimental Epilepsy (M.K., S.S., M. Walker), University College London, Institute of Neurology; and Institute of Cellular Medicine (S.P.), Newcastle University, UK.
Sanjay SisodiyaFrom the Academic Neurology Unit (M.R., J.J.-K.), Royal Hallamshire Hospital, University of Sheffield, UK; Gertrude H. Sergievsky Center (M.C., M. Wall, D.H.), Columbia University, New York, NY; Mental Health Liaison Team (M.B.), Derbyshire Healthcare NHS Foundation Trust Hartington Unit, Chesterfield; Department of Neurology (R.A.G., S.J.H.), Sheffield Teaching Hospitals NHS Foundation Trust; Department of Clinical and Experimental Epilepsy (M.K., S.S., M. Walker), University College London, Institute of Neurology; and Institute of Cellular Medicine (S.P.), Newcastle University, UK.
Matthew WalkerFrom the Academic Neurology Unit (M.R., J.J.-K.), Royal Hallamshire Hospital, University of Sheffield, UK; Gertrude H. Sergievsky Center (M.C., M. Wall, D.H.), Columbia University, New York, NY; Mental Health Liaison Team (M.B.), Derbyshire Healthcare NHS Foundation Trust Hartington Unit, Chesterfield; Department of Neurology (R.A.G., S.J.H.), Sheffield Teaching Hospitals NHS Foundation Trust; Department of Clinical and Experimental Epilepsy (M.K., S.S., M. Walker), University College London, Institute of Neurology; and Institute of Cellular Medicine (S.P.), Newcastle University, UK.
Dale HesdorfferFrom the Academic Neurology Unit (M.R., J.J.-K.), Royal Hallamshire Hospital, University of Sheffield, UK; Gertrude H. Sergievsky Center (M.C., M. Wall, D.H.), Columbia University, New York, NY; Mental Health Liaison Team (M.B.), Derbyshire Healthcare NHS Foundation Trust Hartington Unit, Chesterfield; Department of Neurology (R.A.G., S.J.H.), Sheffield Teaching Hospitals NHS Foundation Trust; Department of Clinical and Experimental Epilepsy (M.K., S.S., M. Walker), University College London, Institute of Neurology; and Institute of Cellular Medicine (S.P.), Newcastle University, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveEpileptic seizures, syncope, and psychogenic nonepileptic seizures (PNES) account for over 90% of presentations with transient loss of consciousness (TLOC). The patient's history is crucial for the diagnosis, but the diagnostic value of individual semiologic features is limited. This study explores the diagnostic potential of a comprehensive questionnaire focusing on TLOC-associated symptoms.

methodsA total of 386 patients with proven epilepsy, 308 patients with proven PNES, and 371 patients with proven syncope were approached by post to recruit 100 patients in each diagnostic group. Symptoms were self-reported on an 86-item questionnaire (the Paroxysmal Event Profile [PEP]) using a 5-point Likert scale (always to never). Data were subjected to exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA). Factors were used to differentiate between diagnoses by pairwise and multinomial regression.

resultsPatients with PNES reported more and more frequent TLOC-associated symptoms than those with epilepsy or syncope (p < 0.001). EFA/CFA identified a 5-factor structure based on 74/86 questionnaire items with loadings ≥0.4. Pairwise logistic regression analysis correctly classified 91% of patients with epilepsy vs those with syncope, 94% of those with PNES vs those with syncope, and 77% of those with epilepsy vs those with PNES. Multinomial logistic regression analysis yielded a similar pattern.

conclusionsClusters of self-reported TLOC symptoms can be used to direct patients to appropriate investigation and treatment pathways for syncope on the one hand and seizures on the other, although additional information is required for a reliable distinction, especially between epilepsy and PNES.

Indexed as

Self ReportAdultChildEpilepsyFactor Analysis, StatisticalFemaleHumansMaleMiddle AgedSeizuresSurveys and QuestionnairesSyncopeUnconsciousness

Identifiers

PMID27385741
PMCPMC4977366

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.