A structured questionnaire predicts if convulsions are epileptic or nonepileptic

Area of Science:

• Neurology
• Clinical Neurophysiology

Background:

• Convulsive seizures are often treated based on clinical assessment alone, lacking definitive video/EEG confirmation.
• A significant number of these seizures may later be identified as having a nonepileptic origin.

Purpose of the Study:

• To evaluate the diagnostic utility of a witness questionnaire in differentiating convulsive epileptic seizures (CES) from convulsive nonepileptic seizures (CNES).

Main Methods:

• Prospective identification of adult patients undergoing video/EEG evaluation for convulsive attacks.
• Interviewing the primary witness using a 12-item questionnaire focusing on ictal and postictal characteristics.

Main Results:

• Video/EEG confirmed CES in 19 patients and CNES in 26 patients.
• The questionnaire demonstrated a predictive accuracy of 84.4% in distinguishing between CES and CNES.
• Key predictors for CNES included ictal eye closure, side-to-side movements, prolonged duration, and specific postictal breathing patterns.

Conclusions:

• A structured witness questionnaire effectively differentiates CES from CNES.
• This tool can assist in identifying patients who would benefit from early video/EEG evaluation.
• Facilitates the prompt initiation of accurate and effective therapeutic interventions.