Reliability of additional reported seizure manifestations to identify dissociative seizures

Wesley T Kerr; Xingruo Zhang; Emily A Janio; Amir H Karimi; Corinne H Allas; Ishita Dubey; Siddhika S Sreenivasan; Janar Bauirjan; Shannon R D'Ambrosio; Mona Al Banna; Andrew Y Cho; Jerome Engel Jr; Mark S Cohen; Jamie D Feusner; John M Stern

doi:10.1016/j.yebeh.2020.107696

Reliability of additional reported seizure manifestations to identify dissociative seizures

Epilepsy Behav. 2021 Feb:115:107696. doi: 10.1016/j.yebeh.2020.107696. Epub 2021 Jan 1.

Authors

Affiliations

¹ Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA. Electronic address: WesleyTK@g.UCLA.edu.
² Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
³ Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.
⁴ Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
⁵ Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA; Departments of Radiology, Psychology, Biomedical Physics, and Bioengineering, University of California Los Angeles, Los Angeles, CA, USA.
⁶ Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; California NanoSystems Institute, University of California Los Angeles, Los Angeles, CA, USA.

Abstract

Purpose: Descriptions of seizure manifestations (SM), or semiology, can help localize the symptomatogenic zone and subsequently included brain regions involved in epileptic seizures, as well as identify patients with dissociative seizures (DS). Patients and witnesses are not trained observers, so these descriptions may vary from expert review of seizure video recordings of seizures. To better understand how reported factors can help identify patients with DS or epileptic seizures (ES), we evaluated the associations between more than 30 SMs and diagnosis using standardized interviews.

Methods: Based on patient- and observer-reported data from 490 patients with diagnoses documented by video-electoencephalography, we compared the rate of each SM in five mutually exclusive groups: epileptic seizures (ES), DS, physiologic seizure-like events (PSLE), mixed DS and ES, and inconclusive testing.

Results: In addition to SMs that we described in a prior manuscript, the following were associated with DS: light triggers, emotional stress trigger, pre-ictal and post-ictal headache, post-ictal muscle soreness, and ictal sensory symptoms. The following were associated with ES: triggered by missing medication, aura of déjà vu, and leftward eye deviation. There were numerous manifestations separately associated with mixed ES and DS.

Conclusions: Reported SM can help identify patients with DS, but no manifestation is pathognomonic for either ES or DS. Patients with mixed ES and DS reported factors divergent from both ES-alone and DS-alone.

Keywords: Functional seizures; Psychogenic nonepileptic seizures; Semiology; Symptomatogenic zone.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Conversion Disorder*
Electroencephalography*
Humans
Reproducibility of Results
Retrospective Studies
Seizures / complications
Seizures / diagnosis

Abstract

Publication types

MeSH terms

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