Do observer and self-reports of ictal eye closure predict psychogenic nonepileptic seizures?
OBJECTIVE
Diagnostic delay in distinguishing psychogenic nonepileptic seizures (PNES) from epileptic seizures may result in unnecessary therapeutic interventions and higher health care costs. Previous studies demonstrated that video-recorded eye closure is associated with PNES. The present study prospectively assessed whether observer or self-report of eye closure could predict PNES, prior to video-EEG monitoring.


METHODS
Adults referred to an epilepsy monitoring unit (EMU) were prospectively enrolled into the study. At baseline, self-report of eye closure was assessed by questionnaire, and observer report was obtained by interview. Physicians viewed video clips independent of EEG tracings and determined the duration of eye closure during PNES and epileptic seizures. We evaluated whether video-recorded eye closure identified an episode as PNES using random effects models that accounted for episode clustering by subject. The utility of observer and self-report of eye closure in predicting a diagnosis of PNES was tested using logistic regression.


RESULTS
Of 132 enrolled subjects, 112 met study criteria during EMU stay for either PNES (n = 43, 38.4%) or epilepsy (n = 84, 75.0%). Fifteen of the 43 PNES subjects (34.9%) had coexisting epilepsy. Self and observer reports of eye closure were neither sensitive nor specific for the diagnosis of PNES. Self-report of eye closure more accurately predicted actual video-recorded eye closure than observer report. Video-recorded eye closure was 92% specific, but only 64% sensitive for PNES identification.


CONCLUSIONS
Neither observer nor self-report of eye closure, prior to VEEG monitoring, predicts PNES. Video-recorded eye closure may not be as sensitive an indicator of PNES as previously reported.
Syed
Tanvir U
TU
Epilepsy Center, The Neurological Institute, University Hospitals Case Medical Center, Cleveland, OH 44106, USA. tsyed1@yahoo.com
Arozullah
Ahsan M
AM
Suciu
Gabriel P
GP
Toub
Julia
J
Kim
Hyunmi
H
Dougherty
Michelle L
ML
Wehner
Tim
T
Stojic
Andrey
A
Syed
Ishtiaq
I
Alexopoulos
Andreas V
AV
D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D015897:Comorbidity; D004569:Electroencephalography / Q000379:methods / Q000706:statistics & numerical data*; D004827:Epilepsy / Q000175:diagnosis; D005143:Eyelids / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods / Q000706:statistics & numerical data; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011602:Psychophysiologic Disorders / Q000175:diagnosis*; D015203:Reproducibility of Results; D012640:Seizures / Q000175:diagnosis* / Q000503:physiopathology; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014743:Videotape Recording