title: Differential diagnosis of a paroxysmal neurological event: Do neurologists know how to clinically recognize it?
abstract: To investigate ability to recognize paroxysmal neurological events (PNE) based on video-recorded events alone in a group of physicians treating prevalent neurological conditions.
  
  
  
  Total of 12 patients' videos (6 epileptic seizures (ES), 4 psychogenic nonepileptic seizures (PNES), 2 other nonepileptic seizures (oNES)) were selected. Videos were displayed once to physicians blind to clinical data and final diagnosis. Physicians determined their clinical choice: ES, PNES, oNES, and I don't know (IDK). When ES was chosen, subjects determined type of ES: focal ES, secondary generalized tonic-clonic seizure (GTCS), primary GTCS, and IDK.
  
  
  
  In total 145 physicians (62% female, mean age 46.2±9years) (neurologists 58.6%, neuropsychiatrists 25.5%, psychiatrists 5%, and neurology residents 10.3%) were enrolled. Physician's exposure to patients with epilepsy per week was diverse: ≤1 patient (43.7%); 1-7 patients (37.2%); >7 patients (14.5%). Reported frequency of observation of PNE was as follows: frequent (21.4%), sometimes (47.6%); rarely (26.9%); never (2.1%). Majority of subjects were not EEG readers (60.7%). Median percentage (Mdn%) of correct answers (CA) was 75% (range 25-100). Predictor of better PNE recognition was higher frequency of clinical exposure to PNE (OR 1.65; CI95% 1.11-2.45; p=0.013). Mdn% of ES CA was 83.3%, (range 33.3-100), and of PNES CA was 50% (range 0-100). Physicians were more accurate in ES than PNES identification (p<0,001). Mdn% of type of ES CA was 50%, (range 0-100).
  
  
  
  We demonstrate the need for education about clinical features of PNE across subgroups of physicians who deliver neurological service, with emphasis on PNES and ES type classification.
authors.affiliation: Center for Epilepsy and Sleep Disorders, Neurology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Serbia. Electronic address: aristic@eunet.rs.
authors.forename: Aleksandar J
authors.initials: AJ
authors.lastname: Ristić
authors.affiliation: Medical School, University of Belgrade, Serbia.
authors.forename: Ksenija
authors.initials: K
authors.lastname: Mijović
authors.affiliation: Institute of Medical Statistics and Informatics, Medical School, University of Belgrade, Serbia.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Bukumirić
authors.affiliation: Center for Epilepsy and Sleep Disorders, Neurology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Serbia.
authors.forename: Nikola
authors.initials: N
authors.lastname: Vojvodić
authors.affiliation: Center for Epilepsy and Sleep Disorders, Neurology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Serbia.
authors.forename: Slavko
authors.initials: S
authors.lastname: Janković
authors.affiliation: Clinic of neurosurgery, Clinical Center of Serbia, Medical School, University of Belgrade, Serbia.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Baščarević
authors.affiliation: Center for Epilepsy and Sleep Disorders, Neurology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Serbia.
authors.forename: Tijana
authors.initials: T
authors.lastname: Đukić
authors.affiliation: Center for Epilepsy and Sleep Disorders, Neurology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Serbia.
authors.forename: Dragoslav
authors.initials: D
authors.lastname: Sokić
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D003937:Diagnosis, Differential; D004569:Electroencephalography / Q000379:methods / Q000592:standards; D004827:Epilepsy / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072141:Neurologists / Q000592:standards*; D012640:Seizures / Q000175:diagnosis* / Q000503:physiopathology* / Q000523:psychology; D014741:Video Recording / Q000379:methods / Q000592:standards*
keywords: Differential diagnosis; Epileptic seizure; Epileptic seizure classification; Neurologist; Paroxysmal neurological event; Psychogenic nonepileptic seizure