Recognition of psychogenic non-epileptic seizures: a curable neurophobia?
- 1Cork University Hospital Neurosciences Department, University College Cork, Ireland
- 2Royal London Hospital Neurosciences Department, Whitechapel, London, UK
- 3Department of Epidemiology, University College Cork, Cork, Ireland
- Correspondence to Dr Sean S O'Sullivan, Department of Neurology, Cork University Hospital, Cork, Ireland;
Contributors All authors had full access to all the data and can take responsibility for the data and analyses. EMMcM prepared summary tables, provided statistical review and assisted in the drafting and approved the final version of the manuscript. SSOS, RR, DH, SOS contributed to the design and conduct of the study, participated in the interpretation of the data, and critically reviewed and approved the manuscript. SSOS is the guarantor.
- Received 24 April 2012
- Revised 4 July 2012
- Accepted 6 July 2012
- Published Online First 28 July 2012
Background Diagnosing psychogenic non-epileptic seizures (PNES) remains challenging. The majority of ‘PNES status’ cases are likely to be seen in the emergency department or similar non-specialised units, where patients are initially assessed and managed by physicians of varying expertise in neurology.
Methods 216 participants including medical students and doctors of all grades from a wide range of medical disciplines were shown video recordings of six patients with PNES and six other patients with convulsive epileptic seizures (ES). Participants were asked to choose between PNES and ES as a diagnosis and to rate their confidence in each diagnosis, both before and after a 15-minute teaching presentation on PNES and ES.
Results Pre-teaching sensitivity for diagnosing PNES was 0.77, specificity 0.55. The positive predictive value (PPV) of diagnosing PNES was 0.63, and was 0.7 for ES. Diagnostic accuracy increased with increasing clinical grades (p=0.022), as did clinical confidence (p<0.0005). Clinical accuracy and clinical confidence increased post-teaching (p<0.0005). Sensitivity for diagnosing PNES post-teaching improved to 0.88, specificity to 0.67. The PPV of diagnosing PNES increased to 0.72, and to 0.84 for ES.
Conclusions Diagnosing PNES can be improved by clinical experience in neurology and focussed teaching interventions.
Competing interests None.
Ethics approval The study was approved by the institutional review board at the Royal London Hospital. Written informed consent for education and research was obtained from all patients (or guardians of patients) whose videos were shown in the study.
Provenance and peer review Not commissioned; externally peer reviewed.