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Reuber, M. orcid.org/0000-0002-4104-6705, Chen, M., Jamnadas-Khoda, J. et al. (9 more authors) (2016) Value of patient-reported symptoms in the diagnosis of transient loss of consciousness. Neurology, 87 (6). pp. 625-633. ISSN 0028-3878
Abstract
OBJECTIVE: Epileptic seizures, syncope, and psychogenic nonepileptic seizures (PNES) account for over 90% of presentations with transient loss of consciousness (TLOC). The patient's history is crucial for the diagnosis, but the diagnostic value of individual semiologic features is limited. This study explores the diagnostic potential of a comprehensive questionnaire focusing on TLOC-associated symptoms. METHODS: A total of 386 patients with proven epilepsy, 308 patients with proven PNES, and 371 patients with proven syncope were approached by post to recruit 100 patients in each diagnostic group. Symptoms were self-reported on an 86-item questionnaire (the Paroxysmal Event Profile [PEP]) using a 5-point Likert scale (always to never). Data were subjected to exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA). Factors were used to differentiate between diagnoses by pairwise and multinomial regression. RESULTS: Patients with PNES reported more and more frequent TLOC-associated symptoms than those with epilepsy or syncope (p < 0.001). EFA/CFA identified a 5-factor structure based on 74/86 questionnaire items with loadings ≥0.4. Pairwise logistic regression analysis correctly classified 91% of patients with epilepsy vs those with syncope, 94% of those with PNES vs those with syncope, and 77% of those with epilepsy vs those with PNES. Multinomial logistic regression analysis yielded a similar pattern. CONCLUSIONS: Clusters of self-reported TLOC symptoms can be used to direct patients to appropriate investigation and treatment pathways for syncope on the one hand and seizures on the other, although additional information is required for a reliable distinction, especially between epilepsy and PNES.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © American Academy of Neurology, 2016 |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > Department of Neuroscience (Sheffield) The University of Sheffield > Sheffield Teaching Hospitals |
Funding Information: | Funder Grant number SHEFFIELD HOSPITALS CHARITABLE TRUST (SPECIAL TRUSTEES) 7859 |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 24 Aug 2016 08:13 |
Last Modified: | 06 May 2020 10:02 |
Published Version: | http://dx.doi.org/10.1212/WNL.0000000000002948 |
Status: | Published |
Publisher: | American Academy of Neurology |
Refereed: | Yes |
Identification Number: | 10.1212/WNL.0000000000002948 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:104021 |
Available Versions of this Item
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Value of patient-reported symptoms in the diagnosis of transient loss of consciousness. (deposited 02 Aug 2016 10:11)
- Value of patient-reported symptoms in the diagnosis of transient loss of consciousness. (deposited 24 Aug 2016 08:13) [Currently Displayed]