Evidence map›Paper›PMID 30884437›Full record

ArticleSeizure2019

Reliability of reported peri-ictal behavior to identify psychogenic nonepileptic seizures.

Wesley T Kerr, Andrea M Chau, Emily A Janio, Chelsea T Braesch, Justine M Le, Jessica M Hori, Akash B Patel, Norma L Gallardo, Janar Bauirjan, Corinne H Allas and 11 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Seizure, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed
–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

11 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

21 authors.

Wesley T KerrDepartment of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA; Department of Internal Medicine, Eisenhower Medical Center, Rancho Mirage, CA, USA; Department of Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA. Electronic address: WesleyTK@g.UCLA.edu.
Andrea M ChauDepartment of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA.
Emily A JanioDepartment of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA.
Chelsea T BraeschDepartment of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA.
Justine M LeDepartment of Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Jessica M HoriDepartment of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA.
Akash B PatelDepartment of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA.
Norma L GallardoDepartment of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA.
Janar BauirjanDepartment of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA.
Corinne H AllasDepartment of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA.
Amir H KarimiDepartment of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA.
Eric S HwangDepartment of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA.
Emily C DavisDepartment of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA.
Albert BuchardDepartment of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA.
David Torres-BarbaDepartment of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA.
Shannon D'AmbrosioDepartment of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA.
Mona Al BannaDepartment of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA.
Andrew Y ChoDepartment of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA.
Jerome EngelDepartment of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Brain Research Institute, UCLA, Los Angeles, CA, USA.
Mark S CohenDepartment of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA; Departments of Radiology, Psychology,Biomedical Physics, and Bioengineering, University of California Los Angeles, Los Angeles, CA, USA; California NanoSystems Institute, University of California Los Angeles, Los Angeles, CA, USA.
John M SternDepartment of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA.

Funding

UCLA-Caltech Medical Scientist Training ProgramT32GM008042 · NIGMS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI AJIJOLA, OLUJIMI A, DAWSON, DAVID WAYNE · 1985 to 2023
$29.9M
IN VIVO STUDIES OF THE EPILEPTIC HIPPOCAMPUSR01NS033310 · NINDS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI JEROME NONE ENGEL, Richard Staba · 1994 to 2026
$7.5M
Comprehensive Training in Neuroimaging Fundamentals and ApplicationsR90DA023422 · NIDA · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI COHEN, MARK STEVEN · 2006 to 2015
$1.7M
The Epilepsy Bioinformatics Study (EpiBioS)P20NS080181 · NINDS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI ENGEL, JEROME NONE, HOVDA, DAVID A · 2012 to 2014
$1.7M
Comprehensive Training in Neuroimaging Fundamentals and ApplicationsT90DA022768 · NIDA · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI COHEN, MARK STEVEN · 2006 to 2015
$1.5M
NIDA NIH HHS R90 DA023422NIDA NIH HHS T90 DA022768NIGMS NIH HHS T32 GM008042NINDS NIH HHS P20 NS080181NINDS NIH HHS R01 NS033310
6 · The paper itself

Abstract

purposeDifferentiating psychogenic non-epileptic seizures (PNES) from epileptic seizures (ES) can be difficult, even when expert clinicians have video recordings of seizures. Moreover, witnesses who are not trained observers may provide descriptions that differ from the expert clinicians', which often raises concern about whether the patient has both ES and PNES. As such, quantitative, evidence-based tools to help differentiate ES from PNES based on patients' and witnesses' descriptions of seizures may assist in the early, accurate diagnosis of patients.

methodsBased on patient- and observer-reported data from 1372 patients with diagnoses documented by video-elect roencephalography (vEEG), we used logistic regression (LR) to compare specific peri-ictal behaviors and seizure triggers in five mutually exclusive groups: ES, PNES, physiologic non-epileptic seizure-like events, mixed PNES plus ES, and inconclusive monitoring. To differentiate PNES-only from ES-only, we retrospectively trained multivariate LR and a forest of decision trees (DF) to predict the documented diagnoses of 246 prospective patients.

resultsThe areas under the receiver operating characteristic curve (AUCs) of the DF and LR were 75% and 74%, respectively (empiric 95% CI of chance 37-62%). The overall accuracy was not significantly higher than the naïve assumption that all patients have ES (accuracy DF 71%, LR 70%, naïve 68%, p > 0.05).

conclusionsQuantitative analysis of patient- and observer-reported peri-ictal behaviors objectively changed the likelihood that a patient's seizures were psychogenic, but these reports were not reliable enough to be diagnostic in isolation. Instead, our scores may identify patients with "probable" PNES that, in the right clinical context, may warrant further diagnostic assessment.

Indexed as

Area Under CurveBrainDecision TreesDiagnosis, Computer-AssistedDiagnosis, DifferentialDissociative DisordersElectroencephalographyFemaleHumansMachine LearningMaleProspective StudiesRetrospective StudiesROC CurveSeizuresSelf ReportClinical decision makingDecision treesDissociative seizuresMachine learningMultiple imputationScreening

Identifiers

PMID30884437
PMCPMC6526032

What OpenQuestion holds

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Read underepoch 390

Registered trials

None linked

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.