1
|
Gündüz M, Gündüz BÖ, Tubas F, Dulkadir R, Çakır BÇ, Çamurdan AD, Ceylan N. The assessment of the knowledge and practices of healthcare providers regarding paroxysmal non-epileptic events (PNES) in children: A cross-sectional study. Epileptic Disord 2024; 26:79-89. [PMID: 37930114 DOI: 10.1002/epd2.20174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Paroxysmal non-epileptic events (PNEs) are a group of disorders that may be misdiagnosed as epilepsy. This study has aimed to assess the knowledge and practices of family physicians and pediatricians regarding the diagnosis, treatment, and follow-up of PNEs in children. METHODS The study was designed as a prospective cross-sectional study that was conducted between March 1, 2022, and June 1, 2022, by reaching pediatric specialists and assistants, family physicians, subspecialty assistants, and subspecialists using a Google questionnaire. The survey consists of 26 questions. The questionnaire used by the researchers was prepared in accordance with the literature search and it included detailed questions on the diagnosis, treatment, and differential diagnosis of PNEs. RESULTS A total of 37.3% worked as specialists. Most of the participants (41.3%) have worked in training and research hospitals, and 44.3% have been physicians for 6-10 years. The mean and standard deviation for the total score were 10.1 ± 2.6. The scores of family physicians were statistically lower than those of specialists, subspecialty assistants, and subspecialists. A total of 67.2% left the decision of whether the patient should stop taking their medication to another clinician. 45% of the doctors said that they were uncomfortable with the diagnosis. SIGNIFICANCE The study findings emphasized the significant knowledge gap among healthcare providers regarding PNEs in children, highlighting the need for targeted educational interventions to improve their understanding and diagnostic skills in this area.
Collapse
Affiliation(s)
- Mehmet Gündüz
- Department of Pediatric Metabolism, Ankara City Hospital, Ankara, Turkey
| | - Bahar Öztelcan Gündüz
- Department of General Pediatrics, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Filiz Tubas
- Department of General Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Ramazan Dulkadir
- Department of General Pediatrics, Ahi Evran University, Faculty of Medicine, Kırşehir, Turkey
| | - Bahar Çuhacı Çakır
- Department of Social Pediatrics, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Aysu Duyan Çamurdan
- Department of Social Pediatrics, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Nesrin Ceylan
- Department of Pediatric Neurology, Yıldırım Beyazıt University, Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
2
|
El Halabi T, Dirani M, Nasreddine W, Hmaimess G, El Sabbagh S, Wazne J, Toufaili H, Hasbini D, Beydoun A. The importance of acknowledging diagnostic uncertainty in patients with new-onset paroxysmal spells. Epilepsia Open 2021; 6:727-735. [PMID: 34596366 PMCID: PMC8633476 DOI: 10.1002/epi4.12544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/13/2021] [Accepted: 09/28/2021] [Indexed: 12/03/2022] Open
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.
Collapse
Affiliation(s)
- Tarek El Halabi
- Neurology DepartmentAmerican University of Beirut Medical CenterBeirutLebanon
| | - Maya Dirani
- Neurology DepartmentAmerican University of Beirut Medical CenterBeirutLebanon
| | - Wassim Nasreddine
- Neurology DepartmentAmerican University of Beirut Medical CenterBeirutLebanon
| | - Ghassan Hmaimess
- Department of PediatricsSaint George Hospital University Medical CenterUniversity of BalamandBeirutLebanon
| | | | | | | | | | - Ahmad Beydoun
- Neurology DepartmentAmerican University of Beirut Medical CenterBeirutLebanon
| |
Collapse
|
3
|
van Houten CB, Naaktgeboren CA, Ashkenazi-Hoffnung L, Ashkenazi S, Avis W, Chistyakov I, Corigliano T, Galetto A, Gangoiti I, Gervaix A, Glikman D, Ivaskeviciene I, Kuperman AA, Lacroix L, Loeffen Y, Luterbacher F, Meijssen CB, Mintegi S, Nasrallah B, Papan C, van Rossum AMC, Rudolph H, Stein M, Tal R, Tenenbaum T, Usonis V, de Waal W, Weichert S, Wildenbeest JG, de Winter-de Groot KM, Wolfs TFW, Mastboim N, Gottlieb TM, Cohen A, Oved K, Eden E, Feigin PD, Shani L, Bont LJ. Expert panel diagnosis demonstrated high reproducibility as reference standard in infectious diseases. J Clin Epidemiol 2019; 112:20-27. [PMID: 30930247 DOI: 10.1016/j.jclinepi.2019.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/24/2019] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE If a gold standard is lacking in a diagnostic test accuracy study, expert diagnosis is frequently used as reference standard. However, interobserver and intraobserver agreements are imperfect. The aim of this study was to quantify the reproducibility of a panel diagnosis for pediatric infectious diseases. STUDY DESIGN AND SETTING Pediatricians from six countries adjudicated a diagnosis (i.e., bacterial infection, viral infection, or indeterminate) for febrile children. Diagnosis was reached when the majority of panel members came to the same diagnosis, leaving others inconclusive. We evaluated intraobserver and intrapanel agreement with 6 weeks and 3 years' time intervals. We calculated the proportion of inconclusive diagnosis for a three-, five-, and seven-expert panel. RESULTS For both time intervals (i.e., 6 weeks and 3 years), intrapanel agreement was higher (kappa 0.88, 95%CI: 0.81-0.94 and 0.80, 95%CI: NA) compared to intraobserver agreement (kappa 0.77, 95%CI: 0.71-0.83 and 0.65, 95%CI: 0.52-0.78). After expanding the three-expert panel to five or seven experts, the proportion of inconclusive diagnoses (11%) remained the same. CONCLUSION A panel consisting of three experts provides more reproducible diagnoses than an individual expert in children with lower respiratory tract infection or fever without source. Increasing the size of a panel beyond three experts has no major advantage for diagnosis reproducibility.
Collapse
Affiliation(s)
- Chantal B van Houten
- Division of Pediatric Immunology and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Christiana A Naaktgeboren
- Division Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - Liat Ashkenazi-Hoffnung
- Schneider Children's Medical Center, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Wim Avis
- Department of Pediatrics, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Irena Chistyakov
- Department of Pediatrics, Bnai Zion Medical Centre, Haifa, Israel
| | - Teresa Corigliano
- Department of Pediatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Annick Galetto
- Department of Pediatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Iker Gangoiti
- Department of Pediatric Emergency Medicine, Cruces University Hospital, Bilbao, Spain
| | - Alain Gervaix
- Department of Pediatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Daniel Glikman
- Infectious Diseases Unit, Padeh Poria Medical Center and the Azrieli faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Inga Ivaskeviciene
- Clinic of Children Diseases, Institute of Clinical medicine, Faculty of Medicine, Vilnius University Vilnius, Lithuania
| | - Amir A Kuperman
- Blood Coagulation Service and Pediatric Hematology Clinic, Galilee Medical Centre, Nahariya, and Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Laurence Lacroix
- Department of Pediatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Yvette Loeffen
- Division of Pediatric Immunology and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Fanny Luterbacher
- Department of Pediatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Clemens B Meijssen
- Department of Pediatrics, Meander Medical Centre, Amersfoort, The Netherlands
| | - Santiago Mintegi
- Department of Pediatric Emergency Medicine, Cruces University Hospital, Bilbao, Spain
| | | | - Cihan Papan
- Pediatric Infectious Diseases, University Children's Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Henriette Rudolph
- Department of Pediatrics, Meander Medical Centre, Amersfoort, The Netherlands
| | - Michal Stein
- Department of Pediatrics, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Roie Tal
- Department of Pediatrics, Galilee Medical Centre, Nahariya and Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Tobias Tenenbaum
- Department of Pediatrics, Meander Medical Centre, Amersfoort, The Netherlands
| | - Vytautas Usonis
- Clinic of Children Diseases, Institute of Clinical medicine, Faculty of Medicine, Vilnius University Vilnius, Lithuania
| | - Wouter de Waal
- Department of Pediatrics, Diakonessenhuis, Utrecht, The Netherlands
| | - Stefan Weichert
- Department of Pediatrics, Meander Medical Centre, Amersfoort, The Netherlands
| | - Joanne G Wildenbeest
- Division of Pediatric Immunology and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karin M de Winter-de Groot
- Department of Pediatric Respiratory Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tom F W Wolfs
- Division of Pediatric Immunology and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | | | | | | | | | - Paul D Feigin
- Faculty of Industrial Engineering and Management, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Louis J Bont
- Division of Pediatric Immunology and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
| | | |
Collapse
|
4
|
van Egmond ME, Contarino MF, Lugtenberg CHA, Peall KJ, Brouwer OF, Fung VSC, Roze E, Stewart RE, Willemsen MA, Wolf NI, de Koning TJ, Tijssen MA. Variable Interpretation of the Dystonia Consensus Classification Items Compromises Its Solidity. Mov Disord 2019; 34:317-320. [PMID: 30726575 DOI: 10.1002/mds.27627] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 12/13/2018] [Accepted: 01/07/2019] [Indexed: 01/16/2023] Open
Affiliation(s)
- Martje E van Egmond
- University of Groningen, University Medical Centre Groningen, Department of Neurology, Groningen, the Netherlands.,Ommelander Ziekenhuis Groningen, Department of Neurology, Scheemda, the Netherlands
| | - Maria Fiorella Contarino
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Neurology, Haga Teaching Hospital, The Hague, the Netherlands
| | - Coen H A Lugtenberg
- University of Groningen, University Medical Centre Groningen, Department of Neurology, Groningen, the Netherlands.,Medisch Spectrum Twente, Department of Neurology, Enschede, the Netherlands
| | - Kathryn J Peall
- Neuroscience and Mental Health Research Institute, Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, United Kingdom
| | - Oebele F Brouwer
- University of Groningen, University Medical Centre Groningen, Department of Neurology, Groningen, the Netherlands
| | - Victor S C Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital & Sydney Medical School, University of Sydney, Sydney, Australia
| | - Emmanuel Roze
- Département de Neurologie, AP-HP, Hôpital Pitié-Salpêtrière and Sorbonne Universités, Université Pierre and Marie Curie, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Roy E Stewart
- University of Groningen, University Medical Centre Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen, the Netherlands
| | - Michel A Willemsen
- Radboud University Medical Centre, Amalia Children's Hospital, Department of Pediatric Neurology, Nijmegen, the Netherlands
| | - Nicole I Wolf
- Department of Child Neurology, Emma Children's Hospital, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam and Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Tom J de Koning
- University of Groningen, University Medical Centre Groningen, Department of Genetics, Groningen, the Netherlands.,University of Groningen, University Medical Centre Groningen, Department of Pediatrics, Groningen, the Netherlands
| | - Marina A Tijssen
- University of Groningen, University Medical Centre Groningen, Department of Neurology, Groningen, the Netherlands
| |
Collapse
|
5
|
Bergin PS, Beghi E, Sadleir LG, Tripathi M, Richardson MP, Bianchi E, D'Souza WJ. Do neurologists around the world agree when diagnosing epilepsy? - Results of an international EpiNet study. Epilepsy Res 2017; 139:43-50. [PMID: 29175563 DOI: 10.1016/j.eplepsyres.2017.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 04/17/2017] [Accepted: 10/20/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Previous studies have shown moderate agreement between physicians when diagnosing epilepsy, but have included small numbers. The EpiNet study group was established to undertake multicentre clinical trials in epilepsy. Before commencing trials, we wanted to determine levels of agreement between physicians from different countries and different health systems when diagnosing epilepsy, specific seizure types and etiologies. METHODS 30 Case scenarios describing six children and 24 adults with paroxysmal events (21 epileptic seizures, nine non-epileptic attacks) were presented to physicians with an interest in epilepsy. Physicians were asked how likely was a diagnosis of epilepsy; if seizures were generalised or focal; and the likely etiology. For 23 cases, clinical information was presented in Step 1, and investigations in Step 2. RESULTS 189 Participants from 36 countries completed the 30 cases. Levels of agreement were determined for 154 participants who provided details regarding their clinical experience. There was substantial agreement for diagnosis of epilepsy (kappa=0.61); agreement was fair to moderate for seizure type(s) (kappa=0.40) and etiology (kappa=0.41). For 23 cases with two steps, agreement increased from step 1 to step 2 for diagnosis of epilepsy (kappa 0.56-0.70), seizure type(s) (kappa 0.38-0.52), and etiology (kappa 0.38-0.47). Agreement was better for 53 epileptologists (diagnosis of epilepsy, kappa=0.66) than 56 neurologists with a special interest in epilepsy (kappa=0.58). Levels of agreement differed slightly between physicians practicing in different parts of the world, between child and adult neurologists, and according to one's experience with epilepsy. CONCLUSION Although there is substantial agreement when epileptologists diagnose epilepsy, there is less agreement for diagnoses of seizure types and etiology. Further education of physicians regarding semiology of different seizure types is required. Differences in approach to diagnosis, both between physicians and between countries, could impact negatively on clinical trials of anti-epileptic drugs.
Collapse
Affiliation(s)
- Peter S Bergin
- Department of Neurology, Auckland City Hospital, Grafton, Auckland, New Zealand.
| | - Ettore Beghi
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
| | - Lynette G Sadleir
- Department of Paediatrics, University of Otago, Wellington, New Zealand.
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Elisa Bianchi
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
| | - Wendyl J D'Souza
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Australia.
| | | |
Collapse
|
6
|
Development and validation of AIIMS modified INCLEN diagnostic instrument for epilepsy in children aged 1 month-18 years. Epilepsy Res 2017; 130:64-68. [PMID: 28157600 DOI: 10.1016/j.eplepsyres.2017.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/12/2017] [Accepted: 01/21/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVES There is shortage of specialists for the diagnosis of children with epilepsy, especially in resource limited settings. Existing INCLEN (International Clinical Epidemiology Network) instrument was validated for children aged 2-9 years. The current study validated modifications of the same including wider symptomatology and age group. METHODS The Modified INCLEN tool was validated by a team of experts by modifying the existing tools (2-9 years) to widen the age range from 1 month to 18 years and include broader symptomatology in a tertiary care teaching hospital of North India between January and June 2015. A qualified medical graduate applied the candidate tool which was followed by gold standard evaluation by a Pediatric Neurologist (both blinded to each other). RESULTS A total of 197 children {128 boys (65%) and 69 girls (35%)}, with a mean age of 72.08 (±50.96) months, completed the study. The sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio of the modified epilepsy tool were 91.5% (84.5-96.1), 88.6% (80.0-93.5), 89.7% (81.9-95.3), 90.8% (83.7-95.7), 8 (6.6-9.8) and 0.09 (0.07-0.12) respectively. SIGNIFICANCE The new modified diagnostic instruments for epilepsy is simple, structured and valid instruments covering 1month to 18 years for use in resource limited settings with acceptable diagnostic accuracy. All seizure semiologies as well as common seizure mimics like breath-holding spells are included in the tool. It also provides for identification of acute symptomatic and febrile seizures.
Collapse
|
7
|
Bergin PS, Beghi E, Sadleir LG, Brockington A, Tripathi M, Richardson MP, Bianchi E, Srivastava K, Jayabal J, Legros B, Ossemann M, McGrath N, Verrotti A, Tan HJ, Beretta S, Frith R, Iniesta I, Whitham E, Wanigasinghe J, Ezeala-Adikaibe B, Striano P, Rosemergy I, Walker EB, Alkhidze M, Rodriguez-Leyva I, Ramírez González JA, D'Souza WJ. EpiNet as a way of involving more physicians and patients in epilepsy research: Validation study and accreditation process. Epilepsia Open 2017; 2:20-31. [PMID: 29750210 PMCID: PMC5939455 DOI: 10.1002/epi4.12033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2016] [Indexed: 11/29/2022] Open
Abstract
Objective EpiNet was established to encourage epilepsy research. EpiNet is used for multicenter cohort studies and investigator‐led trials. Physicians must be accredited to recruit patients into trials. Here, we describe the accreditation process for the EpiNet‐First trials. Methods Physicians with an interest in epilepsy were invited to assess 30 case scenarios to determine the following: whether patients have epilepsy; the nature of the seizures (generalized, focal); and the etiology. Information was presented in two steps for 23 cases. The EpiNet steering committee determined that 21 cases had epilepsy. The steering committee determined by consensus which responses were acceptable for each case. We chose a subset of 18 cases to accredit investigators for the EpiNet‐First trials. We initially focused on 12 cases; to be accredited, investigators could not diagnose epilepsy in any case that the steering committee determined did not have epilepsy. If investigators were not accredited after assessing 12 cases, 6 further cases were considered. When assessing the 18 cases, investigators could be accredited if they diagnosed one of six nonepilepsy patients as having possible epilepsy but could make no other false‐positive errors and could make only one error regarding seizure classification. Results Between December 2013 and December 2014, 189 physicians assessed the 30 cases. Agreement with the steering committee regarding the diagnosis at step 1 ranged from 47% to 100%, and improved when information regarding tests was provided at step 2. One hundred five of the 189 physicians (55%) were accredited for the EpiNet‐First trials. The kappa value for diagnosis of epilepsy across all 30 cases for accredited physicians was 0.70. Significance We have established criteria for accrediting physicians using EpiNet. New investigators can be accredited by assessing 18 case scenarios. We encourage physicians with an interest in epilepsy to become EpiNet‐accredited and to participate in these investigator‐led clinical trials.
Collapse
Affiliation(s)
- Peter S Bergin
- Department of Neurology Auckland City Hospital Auckland New Zealand
| | - Ettore Beghi
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri Milan Italy
| | - Lynette G Sadleir
- Department of Paediatrics University of Otago Wellington New Zealand
| | | | - Manjari Tripathi
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Mark P Richardson
- Division of Neuroscience King's College London London United Kingdom
| | - Elisa Bianchi
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri Milan Italy
| | | | | | - Benjamin Legros
- Department of Neurology Université Libre de Bruxelles Brussels Belgium
| | | | - Nicole McGrath
- Department of Medicine Whangarei Hospital Whangarei New Zealand
| | | | | | - Simone Beretta
- Department of Neurology San Gerardo Hospital ASST Monza Italy
| | - Richard Frith
- Department of Neurology Auckland City Hospital Auckland New Zealand
| | - Ivan Iniesta
- Department of Neurology Palmerston North Hospital Palmerston North New Zealand
| | - Emma Whitham
- Flinders Medical Centre and Flinders University Bedford Park South Australia Australia
| | | | | | | | - Ian Rosemergy
- Department of Neurology Wellington Hospital Wellington New Zealand
| | | | - Maia Alkhidze
- Institute of Neurology and Neuropsychology Tbilisi Georgia
| | | | | | - Wendyl J D'Souza
- Department of Medicine St. Vincent's Hospital The University of Melbourne Melbourne Victoria Australia
| | | |
Collapse
|
8
|
Wardrope A, Reuber M. Diagnosis by Documentary: Professional Responsibilities in Informal Encounters. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2016; 16:40-50. [PMID: 27749168 DOI: 10.1080/15265161.2016.1222008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Most work addressing clinical workers' professional responsibilities concerns the norms of conduct within established professional-patient relationships, but such responsibilities may extend beyond the clinical context. We explore health workers' professional responsibilities in such "informal" encounters through the example of a doctor witnessing the misdiagnosis and mistreatment of a serious long-term condition in a television documentary, arguing that neither internalist approaches to professional responsibility (such as virtue ethics or care ethics) nor externalist ones (such as the "social contract" model) provide sufficiently clear guidance in such situations. We propose that a mix of both approaches, emphasizing the noncomplacency and practical wisdom of virtue ethics, but grounding the normative authority of virtue in an external source, is able to engage with the health worker's responsibilities in such situations to the individual, the health care system, and the population at large.
Collapse
|
9
|
Editorials. Indian Pediatr 2014; 51:535-6. [DOI: 10.1007/s13312-014-0442-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
10
|
Abstract
Epilepsy has protean manifestations and may be diagnosed when two unprovoked seizures have occurred. This determination is nearly always based on the available history because most seizures have stopped long before patients arrive at medical care. Great care must be taken, even by experts, to correctly interpret the history and there is strong evidence that incorrect diagnoses are frequent. An abnormal EEG cannot rule epilepsy in or out unless an actual seizure is recorded. When the diagnosis of epilepsy is based only on two seizures, the seizures are usually generalized tonic-clonic. Less "severe" seizure types usually occur multiple times before prompting a medical visit. Some patients present with what seems to be a first generalized tonic-clonic seizure but have a history of less severe attacks that have not brought them to medical attention - epilepsy can then be diagnosed. Others present with staring spells, episodes of confusion, body jerks, spasms, drops, loss of speech and social interactions and/or cognitive function, paroxysmal events during sleep, and febrile seizures. This chapter examines and considers the differential diagnoses for each of these modes of presentation. The consequences of a missed alternate diagnosis, such as cardiac arrhythmia, may be profound.
Collapse
|
11
|
Paul P, Agarwal M, Bhatia R, Vishnubhatla S, Singh MB. Nurse-led epilepsy follow-up clinic in India: is it feasible and acceptable to patients? A pilot study. Seizure 2013; 23:74-6. [PMID: 24055364 DOI: 10.1016/j.seizure.2013.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 08/29/2013] [Accepted: 09/01/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE India has an epilepsy treatment gap of up to 90%. Shortage of doctors, especially in rural communities makes getting epilepsy treatment almost impossible for the vast majority. Nurses are relatively more in number and available even in smaller cities and villages. This pilot study investigated if a nurse-led epilepsy follow-up clinic is feasible in India and is acceptable to patients. METHOD A II year Nursing postgraduate student was given 8h of didactic teaching tailored for epilepsy patient follow-up, followed by supervised observation time in the epilepsy clinic with a neurologist before conducting epilepsy follow-up clinics independently. Epilepsy patients ≥ 10 years of age and in follow-up for ≥ 6 months were included. They were independently followed-up both in the nurse-led clinic and in the neurologist's clinic. Outcome was measured in terms of interrater agreement (kappa) between the recommendations of the neurologist and the nurse in five domains. Patient satisfaction for nurse-led clinic was also evaluated. RESULTS The interrater agreement between the trained nurse and neurologist in following-up 175 enrolled patients was 76-94%; most unanimity (κ=94%) seen in identifying AED adverse effects while least agreement (κ=76%) was present regarding decisions to modify AED. The mean patient satisfaction score was 37.63 ± 3.26 (maximum possible score 40). CONCLUSION It is feasible for trained nurses to run epilepsy follow-up clinics in India and patients are likely to be satisfied with this approach.
Collapse
Affiliation(s)
- Preethy Paul
- College of Nursing, All India Institute of Medical Sciences, New Delhi, India
| | - Meena Agarwal
- College of Nursing, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Mamta Bhushan Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
| |
Collapse
|
12
|
van der Salm SMA, de Haan RJ, Cath DC, van Rootselaar AF, Tijssen MAJ. The eye of the beholder: inter-rater agreement among experts on psychogenic jerky movement disorders. J Neurol Neurosurg Psychiatry 2013; 84:742-7. [PMID: 23412076 DOI: 10.1136/jnnp-2012-304113] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The current criteria for conversion disorder in the Diagnostic and Statistical Manual of Mental Disorders rely on the assumption that neurological disorders can be distinguished from conversion disorders through clinical assessment. This study aims to assess inter-rater agreement among clinicians with experience in the diagnosis of various hyperkinetic jerky movements, including psychogenic jerks. METHODS 60 patients with psychogenic jerks, myoclonus or tics were rated by international experts using a standardised survey resembling daily clinical practice. The survey included the following diagnostic steps: a short video offering a visual impression of the patients and their jerky movements, medical history, neurological examination (on video), additional investigations and the findings of a standardised psychiatric interview. The diagnosis and diagnostic certainty were scored after each step. RESULTS After all clinical information was given, moderate inter-rater agreement was reached (κ=0.56±0.1) with absolute agreement (100%) of experts on the diagnosis in 12 (20%) patients and reasonable agreement (>75%) in 43 (72%) patients. Psychiatric evaluation did not contribute to inter-rater agreement or diagnostic certainty. CONCLUSIONS Our findings illustrate the fact that experienced movement disorder specialists moderately agree on the clinical diagnosis of jerky movements. Clinical assessment, especially by a team of clinicians in challenging individual cases, might improve diagnostic agreement.
Collapse
Affiliation(s)
- Sandra M A van der Salm
- Department of Neurology AB 51, University Medical Centre Groningen (UMCG), PO Box 30.001, Groningen 9700 RB, The Netherlands.
| | | | | | | | | |
Collapse
|
13
|
van Campen JS, Jansen FE, Brouwer OF, Nicolai J, Braun KPJ. Interobserver agreement of the old and the newly proposed ILAE epilepsy classification in children. Epilepsia 2013; 54:726-32. [DOI: 10.1111/epi.12111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Jolien S. van Campen
- Department of Pediatric Neurology; Rudolf Magnus Institute of Neuroscience; University Medical Center Utrecht; Utrecht; The Netherlands
| | - Floor E. Jansen
- Department of Pediatric Neurology; Rudolf Magnus Institute of Neuroscience; University Medical Center Utrecht; Utrecht; The Netherlands
| | - Oebele F. Brouwer
- Department of Neurology; University Medical Center Groningen; University of Groningen; Groningen; The Netherlands
| | - Joost Nicolai
- Department of Neurology; Maastricht University Medical Center; Maastricht; The Netherlands
| | - Kees P. J. Braun
- Department of Pediatric Neurology; Rudolf Magnus Institute of Neuroscience; University Medical Center Utrecht; Utrecht; The Netherlands
| |
Collapse
|
14
|
Neligan A, Hauser WA, Sander JW. The epidemiology of the epilepsies. HANDBOOK OF CLINICAL NEUROLOGY 2012; 107:113-133. [PMID: 22938966 DOI: 10.1016/b978-0-444-52898-8.00006-9] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Aidan Neligan
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
| | | | | |
Collapse
|
15
|
Dayan PS, Lillis K, Bennett J, Conners G, Bailey P, Callahan J, Akman C, Feldstein N, Hauser WA, Kuppermann N. Interobserver agreement in the assessment of clinical findings in children with first unprovoked seizures. Pediatrics 2011; 127:e1266-71. [PMID: 21482615 DOI: 10.1542/peds.2010-1752] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Variables used in prediction rules and clinical guidelines should show acceptable agreement when assessed by different observers. Our objective was to determine the interobserver agreement of patient history and physical examination variables used to assess children undergoing emergency department (ED) evaluation for a first seizure not provoked by a known precipitant such as fever or trauma (ie, an unprovoked seizure). METHODS We conducted a prospective cohort study of children aged 28 days to 18 years evaluated for unprovoked seizures at 6 tertiary care EDs. We excluded patients if previously evaluated for a similar event. Two clinicians independently completed a clinical assessment before neuroimaging. We determined agreement for each clinical variable by using the unweighted κ statistic. RESULTS A total of 217 paired observations were analyzed; median patient age was 53.5 months, and 38% were younger than 2 years. Agreement beyond chance was at least moderate (κ ≥ 0.41) for 21 of 31 (68%) variables for which κ could be calculated. κ was ≥0.41 for 7 of 11 (64%) general history variables, all 8 seizure-specific history variables (including seizure focality), and 6 of 12 (50%) physical examination variables. Agreement beyond chance was substantial or better (κ ≥ 0.61) for 2 of 11 (18%) general history variables, for 5 of 8 (63%) seizure-specific history variables, and for 2 of 12 (17%) physical examination variables. CONCLUSIONS For children with first unprovoked seizures evaluated in the ED, clinicians frequently assess findings from seizure-specific history with substantial agreement beyond chance. Those clinical variables that have been associated with the presence of intracranial abnormalities and show reliability between assessors, such as seizure focality and the presence of any focal neurological finding, may be more useful in the ED assessment of children with first unprovoked seizures.
Collapse
Affiliation(s)
- Peter S Dayan
- Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York, 622 W 168th St, PH 137, New York, NY 10032, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Massengo S, Ondze B, Bastard J, Guiziou C, Velmans N, Rajabally Y. Elderly patients with epileptic seizures: In-patient observational study of two French community hospitals. Seizure 2011; 20:231-9. [DOI: 10.1016/j.seizure.2010.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 10/04/2010] [Accepted: 11/22/2010] [Indexed: 10/18/2022] Open
|
17
|
Chan D, Phuah HK, Ng YL, Choong CT, Lim KW, Goh WHS. Pediatric epilepsy and first afebrile seizure in Singapore: epidemiology and investigation yield at presentation. J Child Neurol 2010; 25:1216-22. [PMID: 20178999 DOI: 10.1177/0883073809358924] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors studied pediatric epilepsy and first afebrile seizure at presentation in Singapore. A total of 211 participants aged 1 month to 15 years with first presentation for afebrile seizures were recruited from November 2002 to May 2004; 108 with ≥2 prior afebrile seizures (newly diagnosed epilepsy) and 103 with first afebrile seizures. A χ(2) analysis of demographics, risk factors, examination, and investigation findings showed significant differences in development (normal in 87% [newly diagnosed epilepsy] and 93% [first afebrile seizure], P = .046), neurological examination (normal in 92% [newly diagnosed epilepsy] and 98% [first afebrile seizure], P = .016), and electroencephalogram findings (abnormal in 75% [newly diagnosed epilepsy] and 36.9% [first afebrile seizure], P < .005). Pediatric epilepsy incidence at our institution is 24 per 100 000 person-years and is highest in early childhood. Focal epilepsy is more common than generalized epilepsy. Patients with first afebrile seizure and abnormal development, neurological examination, and electroencephalogram findings should be monitored for future development of epilepsy. Population-based studies are recommended.
Collapse
Affiliation(s)
- Derrick Chan
- Neurology Service, Department of Paediatric Medicine, Division of Medicine, KK Women's and Children's Hospital, Singapore.
| | | | | | | | | | | |
Collapse
|
18
|
Abstract
AIM Research has shown computerised tutorial to be as effective as face-to-face teaching in promoting knowledge acquisition. Subsequently, the clinician must synthesise and interpret data (clinical reasoning). This study extends previous research and compares the effectiveness of interactive lecture and computerised tutorial in promoting observational skills and clinical reasoning in the evaluation of paroxysmal events. METHODS The modalities were compared through a randomised crossover trial teaching epilepsy to third and fourth year medical students. The content matter (history and video clip) and format were identical for each topic (Topic 1: altered awareness, Topic 2: movement and posturing) in both modalities (interactive lecture and computerised tutorial). Structured worksheets promoted and evaluated skills of observation and clinical reasoning. Responses in both domains were compared with gold standard qualitative scores. Participants rated modality preference and perceptions of teaching. RESULTS One-hundred and fifty-seven medical students participated. Interactive lecture and computerised tutorial were both effective in promoting observational skills and clinical reasoning with no differences between modalities. Participants preferred the interactive lecture and rated it more enjoyable and effective. Twenty-five participants randomised to the computerised tutorial for Topic 1, elected to withdraw participation. Both modalities promoted interest and willingness to further learn. CONCLUSION This is the first randomised crossover trial evaluating the teaching of clinical reasoning in comparative medical education research. Interactive lecturing and computerised tutorial were both effective in teaching observational skills and clinical reasoning. Interactive lecture is the preferred method, and may influence initial engagement in learning.
Collapse
|
19
|
Abstract
The diagnosis of a first seizure or epilepsy may be subject to interobserver variation and inaccuracy with possibly far-reaching consequences for the patients involved. We reviewed the current literature. Studies on the interobserver variation of the diagnosis of a first seizure show that such a diagnosis is subject to considerable interobserver disagreement. Interpretation of the electroencephalogram (EEG) findings is also subject to interobserver disagreement and is influenced by the threshold of the reader to classify EEG findings as epileptiform. The accuracy of the diagnosis of epilepsy varies from a misdiagnosis rate of 5% in a prospective childhood epilepsy study in which the diagnosis was made by a panel of three experienced pediatric neurologists to at least 23% in a British population-based study, and may be even higher in everyday practice. The level of experience of the treating physician plays an important role. The EEG may be helpful but one should be reluctant to make a diagnosis of epilepsy mainly on the EEG findings without a reasonable clinical suspicion based on the history. Being aware of the possible interobserver variation and inaccuracy, adopting a systematic approach to the diagnostic process, and timely referral to specialized care may be helpful to prevent the misdiagnosis of epilepsy.
Collapse
Affiliation(s)
- Cees A van Donselaar
- Department of Neurology, Medical Centre Rijnmond-South, Rotterdam, The Netherlands.
| | | | | |
Collapse
|
20
|
Stephenson JBP. Clinical diagnosis of syncopes (including so-called breath-holding spells) without electroencephalography or ocular compression. J Child Neurol 2007; 22:502-8. [PMID: 17621539 DOI: 10.1177/0883073807301937] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A recent article in this journal suggested that ocular compression during electroencephalography was useful in distinguishing "breath-holding spells and syncope" from epileptic seizures. The method proposed involved measurement of the RR interval on the simultaneously recorded electrocardiographic trace and determining both the absolute RR lengthening and the change in RR interval as compared with the baseline value. It is argued by the present author that this is not an appropriate way to come to a diagnosis in episodic loss of consciousness in children. It is pointed out that so-called "breath-holding spells" are reflex syncopes and that the diagnosis of reflex syncopes should be by clinical history, even if this means delaying the diagnosis until a future consultation. Published evidence on the nature and clinical diagnosis of reflex syncopes in infants and children is reviewed in depth. It is concluded that routine electroencephalography is not an appropriate investigation when the diagnosis of episodic loss of consciousness is in doubt and has the implicit danger of false positive "abnormality". Aside from scientific exploration of the developing autonomic nervous system, the only current indication for diagnostic ocular compression is to induce a syncope so that its nature may be better understood. Such a circumstance might be a history of an apparent reflex syncope but with atypical features, including prolonged post-syncopal unconsciousness such as might indicate epileptic absence status. Several additional investigations of a primarily cardiological nature may be indicated in some cases, but a wait-and-see policy is usually to be preferred.
Collapse
|
21
|
Uldall P, Alving J, Hansen LK, Kibaek M, Buchholt J. The misdiagnosis of epilepsy in children admitted to a tertiary epilepsy centre with paroxysmal events. Arch Dis Child 2006; 91:219-21. [PMID: 16492886 PMCID: PMC2065931 DOI: 10.1136/adc.2004.064477] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To determine the proportion of children admitted with difficult to treat paroxysmal events to a tertiary epilepsy centre who did not have epilepsy. METHODS In an observational retrospective study, all case notes of 223 children admitted in 1997 were examined. The referral was made from the local paediatric department in 51% of cases, other departments in 27%, and from general or specialist practitioners in 22%. Doubt regarding the diagnosis of epilepsy was expressed in the referral note in 17%. On admission, 86% were on antiepileptic drug treatment. During admission all children were subjected to a comprehensive intensive observation and 62% had EEG monitoring. RESULTS In total, 39% (87/223) were found not to have epilepsy. In 30% of children (55/184) referred without any doubts about the epilepsy diagnosis, the diagnosis was disproved. Of the 159 children admitted for the first time, 75 (47%) were discharged with a diagnosis of non-epileptic seizures. Of 125 children admitted for the first time with no doubts about the diagnosis of epilepsy, 44 (35%) did not have epilepsy. Staring episodes were the most frequently encountered non-epileptic paroxysmal event. Psychogenic non-epileptic seizures were found in 12 children. A total of 34 (15%) had their medication tapered off; a further 22 (10%) had tapered off medication before admission. CONCLUSION The present study supports the view that misdiagnosis of epilepsy is common. The treating physician should be cautious in diagnosis, especially of staring episodes. A diagnostic re-evaluation should be undertaken in difficult cases with continuing paroxysmal events in order to avoid unnecessary drug treatment and restrictions on the child's lifestyle.
Collapse
Affiliation(s)
- P Uldall
- Danish Epilepsy Centre, Kolonivej 1, DK-4293 Dianalund, Denmark.
| | | | | | | | | |
Collapse
|
22
|
Beach R, Reading R. The importance of acknowledging clinical uncertainty in the diagnosis of epilepsy and non-epileptic events. Arch Dis Child 2005; 90:1219-22. [PMID: 16131503 PMCID: PMC1720220 DOI: 10.1136/adc.2004.065441] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Failure to recognise diagnostic uncertainty between the epilepsies and non-epileptic events may be a factor in high rates of misdiagnosis. AIMS To explore the results of acknowledging diagnostic uncertainty in a cohort of children presenting with paroxysmal events. METHODS Children (29 days-16th birthday) with new presentations of paroxysmal disorders were ascertained through outpatients, admissions, and accident and emergency over a two year period in a district hospital with a catchment population of 500,000. Cases were classified by diagnosis at entry and 6-30 months later. A random selection of cases was independently assessed. RESULTS A total of 684 cases were ascertained. Attacks were initially classified as febrile seizures (n = 212), acute symptomatic epileptic seizures (n = 5), epilepsies (n = 83), unclassified (possible epilepsy) (n = 90), isolated epileptic seizures (n = 51), and non-epileptic events (n = 243). Case review enabled reclassification of 61 of those initially unclassified--31 to an epilepsy and 27 to non-epileptic events. In 29 the final diagnosis was never clarified. These were 23 cases with confusing or absent histories and six with short lived seizure clusters. Prognosis for these 29 cases was good; 75% had been discharged. None were on long term medication. The diagnosis in the 131 cases confirmed as epilepsy was stable. Independent review of a random sample showed full concordance with one neurologist and 20% uncertainty with another. CONCLUSION In addition to definite epilepsy or non-epileptic events it is helpful to recognise a group of cases where the diagnosis is uncertain-unclassified paroxysmal events. Reassessment of these cases enables accurate diagnosis and may prevent a hasty and incorrect diagnosis of epilepsy.
Collapse
Affiliation(s)
- R Beach
- Norfolk and Norwich University Hospital, Norwic, UK.
| | | |
Collapse
|
23
|
Oostrom KJ, van Teeseling H, Smeets-Schouten A, Peters ACB, Jennekens-Schinkel A. Three to four years after diagnosis: cognition and behaviour in children with 'epilepsy only'. A prospective, controlled study. ACTA ACUST UNITED AC 2005; 128:1546-55. [PMID: 15817514 DOI: 10.1093/brain/awh494] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A 3.5-year follow-up study of cognition and behaviour in 42 children with newly diagnosed idiopathic or cryptogenic epilepsy ('epilepsy only') attending mainstream education and 30 healthy gender-matched classmate controls was carried out to identify differences between groups, to detect factors that contribute to the difference and its change over time, and to establish the proportion of poorly performing children. The neuropsychological battery covered the major domains of cognition, mental and motor speed and academic language skills. Children were tested at the time of diagnosis (before any anti-epileptic drug treatment started) and 3, 12 and approximately 42 months later. Parents and teachers completed behaviour checklists, for which the scoring was adapted to prevent any influence of epilepsy-related ambiguity. Based on parental interviews at the time of diagnosis, children with epilepsy were categorized as having longstanding behavioural and/or learning problems, as belonging to a troubled family, as being exposed to 'off-balance' parenting starting at the time of epilepsy onset and/or as reacting maladaptively to the changes in relation to the onset of epilepsy. Throughout follow-up, the group of children with epilepsy only performed less well than healthy classmates on measures of learning, memory span for words, attention and behaviour. After controlling for school delay, proactive interference (number of responses to the same images as in the learning trials, but now presented in reordered locations) was the only remaining variable that distinguished the group of children with epilepsy only. Group-wise, no changes in cognitive and behavioural differences over time were found, but instability in individual performances appeared to characterize children with epilepsy only. Rather than intrinsically epilepsy-related variables, such as idiopathic versus cryptogenic aetiology, seizure control or anti-epileptic drug treatment, the child's prediagnostic learning and behavioural histories and the parents' ability to continue their habitual parenting in the face of the diagnosis of epilepsy only were shown by both group-wise and case-by-case analyses to be important for understanding the cognitive and behavioural functioning of the children with epilepsy only.
Collapse
Affiliation(s)
- K J Oostrom
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neuropsychology, The Netherlands.
| | | | | | | | | |
Collapse
|