The aim of this study was to evaluate the diagnostic accuracy of common interview questions used to distinguish a diagnosis of epilepsy from seizure mimics including non-epileptic seizures (NES), migraine, and syncope. 200 outpatients were recruited with an established diagnosis of focal epilepsy (n = 50), NES (n = 50), migraine (n = 50), and syncope (n = 50). Patients completed an eight-item, yes-or-no online questionnaire about symptoms related to their events. Sensitivity and specificity were calculated. Using a weighted scoring for the questions alone with baseline characteristics, the overall questionnaire was tested for diagnostic accuracy. Of individual questions, the most sensitive one asked if events are sudden in onset (98 % sensitive for epilepsy (95 % CI: 89 %, 100 %)). The least sensitive question asked if events are stereotyped (46 % sensitive for epilepsy (95 % CI: 32 %, 60 %)). Overall, three of the eight questions showed an association with epilepsy as opposed to mimics. These included questions about “sudden onset” (OR 10.76, 95 % CI: (1.66, 449.21) p = 0.0047), “duration < 5 min” (OR 3.34, 95 % CI: (1.62, 6.89), p = 0.0008), and “duration not > 30 min” (OR 4.44, 95 % CI: (1.94, 11.05), p = <0.0001). When individual seizure mimics were compared to epilepsy, differences in responses were most notable between the epilepsy and migraine patients. Syncope and NES were most similar in responses to epilepsy. The overall weighted questionnaire incorporating patient age and sex produced an area under the ROC curve of 0.80 (95 % CI: 0.74, 0.87)). In this study, we examined the ability of common interview questions used by physicians to distinguish between epilepsy and prevalent epilepsy mimics, specifically NES, migraines, and syncope. Using a weighted scoring system for questions, and including age and sex, produced a sensitive and specific predictive model for the diagnosis of epilepsy. In contrast to many prior studies which evaluated either a large number of questions or used methods with difficult practical application, our study is unique in that we tested a small number of easy-to-understand “yes” or “no” questions that can be implemented in most clinical settings by non-specialists.

中文翻译：

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测试癫痫诊断常见问题的诊断准确性：挑战和未来方向

本研究的目的是评估常见访谈问题的诊断准确性，这些问题用于区分癫痫的诊断和类似癫痫发作的症状，包括非癫痫发作（NES）、偏头痛和晕厥。招募了 200 名门诊患者，确诊为局灶性癫痫 (n = 50)、NES (n = 50)、偏头痛 (n = 50) 和晕厥 (n = 50)。患者完成了一份包含八项是或否的在线调查问卷，内容涉及与其事件相关的症状。计算灵敏度和特异性。使用单独的问题加权评分和基线特征，测试整个调查问卷的诊断准确性。在个别问题中，最敏感的问题是询问事件是否突然发生（98% 对癫痫敏感（95% CI：89%、100%））。最不敏感的问题是询问事件是否具有刻板印象（癫痫敏感度为 46%（95% CI：32%、60%））。总体而言，八个问题中的三个显示与癫痫相关，而不是模仿。其中包括有关“突然发作”（OR 10.76，95 % CI：（1.66，449.21）p = 0.0047）、“持续时间 < 5 分钟”（OR 3.34，95 % CI：（1.62，6.89），p = 0.0008）的问题，以及“持续时间不 > 30 分钟”（OR 4.44，95 % CI：（1.94，11.05），p = <0.0001）。当将个体癫痫发作与癫痫进行比较时，癫痫和偏头痛患者之间的反应差异最为显着。晕厥和 NES 对癫痫的反应最为相似。纳入患者年龄和性别的总体加权问卷得出的 ROC 曲线下面积为 0.80（95% CI：0.74，0.87）。在这项研究中，我们检查了医生使用常见访谈问题来区分癫痫和流行的癫痫模仿现象（特别是 NES、偏头痛和晕厥）的能力。使用包括年龄和性别在内的问题加权评分系统，为癫痫的诊断产生了敏感且特异的预测模型。与许多先前评估大量问题或使​​用难以实际应用的方法的研究相比，我们的研究的独特之处在于我们测试了少量易于理解的“是”或“否”问题，这些问题可以在大多数临床环境中由非专家实施。