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Interobserver reliability of a recently proposed semiological classification in psychogenic nonepileptic seizures in
Hakan Ercelebi1, Pinar Ozbudak2, Tugba Hirfanoglu3
1Gülhane Training and Research Hospital, Department of Pediatrics, Department of Pediatric Neurology, University of Health Sciences, Ankara, Turkey.
Insights
A new classification system for Psychogenic Nonepileptic Seizures (PNES) in children demonstrated higher interobserver reliability than older methods. This improved classification is valuable for managing pediatric PNES.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Neuroscience
Background:
- Psychogenic Nonepileptic Seizures (PNES) present unique semiological challenges in pediatric populations.
- Accurate classification is crucial for effective diagnosis and management of PNES in children.
- Evaluating the reliability of different classification systems is essential for clinical practice.
Purpose of the Study:
- To analyze the semiological characteristics of PNES in pediatric patients.
- To assess and compare the interobserver reliability of two distinct PNES classification systems.
- To identify factors contributing to agreement or disagreement between observers in PNES classification.
Main Methods:
- Analysis of semiological features in 137 pediatric patients diagnosed with PNES.
- Two independent, blinded observers evaluated patient semiology using the Asadi-Pooya and Seneviratne et al. classification systems.
- Interobserver reliability was quantified using the kappa (κ) coefficient for each classification.
Main Results:
- The study included 137 pediatric patients (69.3% female, mean age 14.3 years).
- Common semiologies included ictal eye closure (79.5%), asymmetric limb movements (51.8%), and prolonged motor phenomena (>2 min, 50.3%).
- The Asadi-Pooya classification showed significantly higher interobserver reliability (κ=0.697) compared to the Seneviratne classification (κ=0.433).
Conclusions:
- The Asadi-Pooya classification system demonstrates superior interobserver reliability for pediatric PNES compared to earlier systems.
- A simple yet comprehensive classification system enhances diagnostic consistency among experienced pediatric neurologists.
- Improved classification reliability is influential in the effective management of pediatric Psychogenic Nonepileptic Seizures.
Background:
The aim of this study is to examine the semiological features of Psychogenic Nonepileptic Seizures (PNES) in children and to evaluate interobserver reliability (IR) of two different classifications. to identify the sources of any variance in agreement and to estimate the IR of the classification systems METHODS: Semiological features of 137 pediatric patients with PNES with and without epilepsy were analyzed. Two different, blinded observers evaluated these semiological features according to A. Asadi-Pooya and Seneviratne et al. classifications. The interobserver reliability was measured using a kappa (κ) coefficient for each PNES classification.
Results:
The mean age of patients with PNES was 14.3 (SD: 2.9) years. Ninety five patients were female (69.3 %), 42 were male (30.6 %). Ictal eye closure (n:109, 79.5 %), was the most common seizure semiology. Asymmetric limb movements (n: 71, 51.8 %), motor phenomenon lasting> two minutes (n:69, 50.3 %), and closed mouth (n:53, 38.6 %) were other common seizure semiologies of PNES. Kappa value was higher in A. Asadi-Pooya classification than Seneviratne classification (k = 0.697 and k = 0.433; p < 0.05). Kappa values were higher in the motor and non-motor categories of A. Asadi-Pooya classification than in the mixed category (k = 0.713, k = 0.799 and k = 0.455; p < 0.05).
Conclusion:
The added value of the new classification scheme with respect to uniform application by experienced pediatric neurologists seems to be reliable and influential, as interobserver reliability of the new classification system was higher than the early classification. Our findings suggest that a simple but comprehensive classification would be useful in the management of PNES.
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