The importance of acknowledging diagnostic uncertainty in patients with new‐onset paroxysmal spells

Abstract Objective The aims of this study were to evaluate the frequency of paroxysmal spells of indeterminate nature (PSIN) in a large cohort of children and adults with suspected new‐onset seizures, to evaluate the reasons for including patients in this category, and to calculate the rate of erron...

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Autores principales:	Tarek El Halabi, Maya Dirani, Wassim Nasreddine, Ghassan Hmaimess, Sandra El Sabbagh, Jaafar Wazne, Hassan Toufaili, Dana Hasbini, Ahmad Beydoun
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	epileptic seizures nonepileptic spells paroxysmal spells prospective study unclassified spells Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/c101318a88324d1193e7f0d8850a05c0
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spelling	oai:doaj.org-article:c101318a88324d1193e7f0d8850a05c02021-12-01T06:09:19ZThe importance of acknowledging diagnostic uncertainty in patients with new‐onset paroxysmal spells2470-923910.1002/epi4.12544https://doaj.org/article/c101318a88324d1193e7f0d8850a05c02021-12-01T00:00:00Zhttps://doi.org/10.1002/epi4.12544https://doaj.org/toc/2470-9239Abstract Objective The aims of this study were to evaluate the frequency of paroxysmal spells of indeterminate nature (PSIN) in a large cohort of children and adults with suspected new‐onset seizures, to evaluate the reasons for including patients in this category, and to calculate the rate of erroneous diagnoses if the epileptologists were compelled to label those events as epileptic seizures or nonepileptic paroxysmal spells. Methods Patients identified for this study participated in a prospective study evaluating patients with suspected new‐onset unprovoked seizures. The workup included a detailed history and a thorough description of the spells, a 3‐hour video EEG recording, and an epilepsy protocol brain MRI. Based exclusively on a detailed description of the ictal events, two epileptologists were asked to independently classify each patient into those with a definite diagnosis of unprovoked seizures or a definite diagnosis of a nonepileptic paroxysmal spells (group 1) and those with PSIN (group 2). Results A total of 1880 consecutive patients were enrolled with 255 (13.6%) included in the PSIN group. Patients with PSIN were significantly younger than those with a definite diagnosis, and PSIN were significantly more frequent in children with developmental delay. The most common reason for including patients in the PSIN group was the inability to categorically discriminate between a seizure and a nonepileptic mimicker. When the raters were compelled to classify the spells in the PSIN group, the frequencies of erroneous diagnoses ranged between 32% and 38%. The final diagnoses on those patients were made based on the results of the EEG, MRI, and follow‐up visits. Significance Our data indicate that a diagnostic category of PSIN should be recognized and ought to be used in clinical practice. Acknowledging this uncertainty will result in lower frequencies of erroneous diagnoses, possible stigma, and potential exposure to unnecessary antiseizure medications.Tarek El HalabiMaya DiraniWassim NasreddineGhassan HmaimessSandra El SabbaghJaafar WazneHassan ToufailiDana HasbiniAhmad BeydounWileyarticleepileptic seizuresnonepileptic spellsparoxysmal spellsprospective studyunclassified spellsNeurology. Diseases of the nervous systemRC346-429ENEpilepsia Open, Vol 6, Iss 4, Pp 727-735 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	epileptic seizures nonepileptic spells paroxysmal spells prospective study unclassified spells Neurology. Diseases of the nervous system RC346-429
spellingShingle	epileptic seizures nonepileptic spells paroxysmal spells prospective study unclassified spells Neurology. Diseases of the nervous system RC346-429 Tarek El Halabi Maya Dirani Wassim Nasreddine Ghassan Hmaimess Sandra El Sabbagh Jaafar Wazne Hassan Toufaili Dana Hasbini Ahmad Beydoun The importance of acknowledging diagnostic uncertainty in patients with new‐onset paroxysmal spells
description	Abstract Objective The aims of this study were to evaluate the frequency of paroxysmal spells of indeterminate nature (PSIN) in a large cohort of children and adults with suspected new‐onset seizures, to evaluate the reasons for including patients in this category, and to calculate the rate of erroneous diagnoses if the epileptologists were compelled to label those events as epileptic seizures or nonepileptic paroxysmal spells. Methods Patients identified for this study participated in a prospective study evaluating patients with suspected new‐onset unprovoked seizures. The workup included a detailed history and a thorough description of the spells, a 3‐hour video EEG recording, and an epilepsy protocol brain MRI. Based exclusively on a detailed description of the ictal events, two epileptologists were asked to independently classify each patient into those with a definite diagnosis of unprovoked seizures or a definite diagnosis of a nonepileptic paroxysmal spells (group 1) and those with PSIN (group 2). Results A total of 1880 consecutive patients were enrolled with 255 (13.6%) included in the PSIN group. Patients with PSIN were significantly younger than those with a definite diagnosis, and PSIN were significantly more frequent in children with developmental delay. The most common reason for including patients in the PSIN group was the inability to categorically discriminate between a seizure and a nonepileptic mimicker. When the raters were compelled to classify the spells in the PSIN group, the frequencies of erroneous diagnoses ranged between 32% and 38%. The final diagnoses on those patients were made based on the results of the EEG, MRI, and follow‐up visits. Significance Our data indicate that a diagnostic category of PSIN should be recognized and ought to be used in clinical practice. Acknowledging this uncertainty will result in lower frequencies of erroneous diagnoses, possible stigma, and potential exposure to unnecessary antiseizure medications.
format	article
author	Tarek El Halabi Maya Dirani Wassim Nasreddine Ghassan Hmaimess Sandra El Sabbagh Jaafar Wazne Hassan Toufaili Dana Hasbini Ahmad Beydoun
author_facet	Tarek El Halabi Maya Dirani Wassim Nasreddine Ghassan Hmaimess Sandra El Sabbagh Jaafar Wazne Hassan Toufaili Dana Hasbini Ahmad Beydoun
author_sort	Tarek El Halabi
title	The importance of acknowledging diagnostic uncertainty in patients with new‐onset paroxysmal spells
title_short	The importance of acknowledging diagnostic uncertainty in patients with new‐onset paroxysmal spells
title_full	The importance of acknowledging diagnostic uncertainty in patients with new‐onset paroxysmal spells
title_fullStr	The importance of acknowledging diagnostic uncertainty in patients with new‐onset paroxysmal spells
title_full_unstemmed	The importance of acknowledging diagnostic uncertainty in patients with new‐onset paroxysmal spells
title_sort	importance of acknowledging diagnostic uncertainty in patients with new‐onset paroxysmal spells
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/c101318a88324d1193e7f0d8850a05c0
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The importance of acknowledging diagnostic uncertainty in patients with new‐onset paroxysmal spells

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