title: Using interactional and linguistic analysis to distinguish between epileptic and psychogenic nonepileptic seizures: a prospective, blinded multirater study.
abstract: This study was carried out to test the suggestion that close interactional and linguistic examination of the communication between neurologists and patients during a first encounter can contribute to the differential diagnosis of epilepsy or psychogenic nonepileptic seizures. Twenty unselected patients admitted for video/EEG telemetry because of diagnostic uncertainty were included. Two linguists blinded to all medical data independently studied video recordings and transcripts of 25- to 35-minute interactions. They attempted to predict the medical diagnosis on the basis of qualitative assessments addressing 17 separate observations. They also used a diagnostic scoring aid (DSA) to convert their qualitative assessments into a simple numeric score. Using qualitative assessment, both linguists predicted 17 of 20 (85%) diagnoses (kappa=0.59). With the DSA, diagnoses were predicted with a sensitivity of 85.7% (71.4%) and a specificity of 84.6% (92.3%). This blinded, prospective multirater study confirms the diagnostic value of linguistic and interactional observations in the seizure clinic setting.
authors.affiliation: Academic Neurology Unit, University of Sheffield, Sheffield, UK. markus.reuber@sth.nhs.uk
authors.forename: Markus
authors.initials: M
authors.lastname: Reuber
authors.forename: Chiara
authors.initials: C
authors.lastname: Monzoni
authors.forename: Basil
authors.initials: B
authors.lastname: Sharrack
authors.forename: Leendert
authors.initials: L
authors.lastname: Plug
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D003937:Diagnosis, Differential; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015588:Observer Variation; D011446:Prospective Studies; D011578:Psycholinguistics; D015203:Reproducibility of Results; D012640:Seizures / Q000175:diagnosis*