Wesley T Kerr1,2,3, Emily A Janio3, Chelsea T Braesch3, Justine M Le3, Jessica M Hori3, Akash B Patel3, Norma L Gallardo3, Janar Bauirjan3, Shannon R D'Ambrosio3, Andrea M Chau3, Eric S Hwang3, Emily C Davis3, Albert Buchard3, David Torres-Barba3, Mona Al Banna3, Sarah E Barritt3, Andrew Y Cho3, Jerome Engel3,4,5, Mark S Cohen3,4,6,7, John M Stern4. 1. Department of Internal Medicine, Eisenhower Medical Center, Rancho Mirage, California, U.S.A. 2. Department of Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A. 3. Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, U.S.A. 4. Departments of Neurology and Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A. 5. Brain Research Institute, University of California, Los Angeles, Los Angeles, California, U.S.A. 6. Departments of Radiology, Psychology, Biomedical Physics, and Bioengineering, University of California, Los Angeles, Los Angeles, California, U.S.A. 7. California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California, U.S.A.
Abstract
OBJECTIVE: Low-cost evidence-based tools are needed to facilitate the early identification of patients with possible psychogenic nonepileptic seizures (PNES). Prior to accurate diagnosis, patients with PNES do not receive interventions that address the cause of their seizures and therefore incur high medical costs and disability due to an uncontrolled seizure disorder. Both seizures and comorbidities may contribute to this high cost. METHODS: Based on data from 1,365 adult patients with video-electroencephalography-confirmed diagnoses from a single center, we used logistic and Poisson regression to compare the total number of comorbidities, number of medications, and presence of specific comorbidities in five mutually exclusive groups of diagnoses: epileptic seizures (ES) only, PNES only, mixed PNES and ES, physiologic nonepileptic seizurelike events, and inconclusive monitoring. To determine the diagnostic utility of comorbid diagnoses and medication history to differentiate PNES only from ES only, we used multivariate logistic regression, controlling for sex and age, trained using a retrospective database and validated using a prospective database. RESULTS: Our model differentiated PNES only from ES only with a prospective accuracy of 78% (95% confidence interval =72-84%) and area under the curve of 79%. With a few exceptions, the number of comorbidities and medications was more predictive than a specific comorbidity. Comorbidities associated with PNES were asthma, chronic pain, and migraines (p < 0.01). Comorbidities associated with ES were diabetes mellitus and nonmetastatic neoplasm (p < 0.01). The population-level analysis suggested that patients with mixed PNES and ES may be a population distinct from patients with either condition alone. SIGNIFICANCE: An accurate patient-reported medical history and medication history can be useful when screening for possible PNES. Our prospectively validated and objective score may assist in the interpretation of the medication and medical history in the context of the seizure description and history. Wiley Periodicals, Inc.
OBJECTIVE: Low-cost evidence-based tools are needed to facilitate the early identification of patients with possible psychogenic nonepileptic seizures (PNES). Prior to accurate diagnosis, patients with PNES do not receive interventions that address the cause of their seizures and therefore incur high medical costs and disability due to an uncontrolled seizure disorder. Both seizures and comorbidities may contribute to this high cost. METHODS: Based on data from 1,365 adult patients with video-electroencephalography-confirmed diagnoses from a single center, we used logistic and Poisson regression to compare the total number of comorbidities, number of medications, and presence of specific comorbidities in five mutually exclusive groups of diagnoses: epileptic seizures (ES) only, PNES only, mixed PNES and ES, physiologic nonepileptic seizurelike events, and inconclusive monitoring. To determine the diagnostic utility of comorbid diagnoses and medication history to differentiate PNES only from ES only, we used multivariate logistic regression, controlling for sex and age, trained using a retrospective database and validated using a prospective database. RESULTS: Our model differentiated PNES only from ES only with a prospective accuracy of 78% (95% confidence interval =72-84%) and area under the curve of 79%. With a few exceptions, the number of comorbidities and medications was more predictive than a specific comorbidity. Comorbidities associated with PNES were asthma, chronic pain, and migraines (p < 0.01). Comorbidities associated with ES were diabetes mellitus and nonmetastatic neoplasm (p < 0.01). The population-level analysis suggested that patients with mixed PNES and ES may be a population distinct from patients with either condition alone. SIGNIFICANCE: An accurate patient-reported medical history and medication history can be useful when screening for possible PNES. Our prospectively validated and objective score may assist in the interpretation of the medication and medical history in the context of the seizure description and history. Wiley Periodicals, Inc.
Authors: Jerzy P Szaflarski; Magdalena Szaflarski; Cindy Hughes; David M Ficker; William T Cahill; Michael D Privitera Journal: Med Sci Monit Date: 2003-04
Authors: Wesley T Kerr; Emily A Janio; Chelsea T Braesch; Justine M Le; Jessica M Hori; Akash B Patel; Sarah E Barritt; Norma L Gallardo; Janar Bauirjan; Andrea M Chau; Eric S Hwang; Emily C Davis; David Torres-Barba; Andrew Y Cho; Jerome Engel; Mark S Cohen; John M Stern Journal: Epilepsy Behav Date: 2017-02-23 Impact factor: 2.937
Authors: Wesley T Kerr; Andrea M Chau; Emily A Janio; Chelsea T Braesch; Justine M Le; Jessica M Hori; Akash B Patel; Norma L Gallardo; Janar Bauirjan; Corinne H Allas; Amir H Karimi; Eric S Hwang; Emily C Davis; Albert Buchard; David Torres-Barba; Shannon D'Ambrosio; Mona Al Banna; Andrew Y Cho; Jerome Engel; Mark S Cohen; John M Stern Journal: Seizure Date: 2019-03-05 Impact factor: 3.184
Authors: Wesley T Kerr; Emily A Janio; Andrea M Chau; Chelsea T Braesch; Justine M Le; Jessica M Hori; Akash B Patel; Norma L Gallardo; Corinne H Allas; Amir H Karimi; Ishita Dubey; Siddhika S Sreenivasan; Janar Bauirjan; Eric S Hwang; Emily C Davis; Shannon R D'Ambrosio; Mona Al Banna; Rajarshi Mazumder; Ting Wu; Zachary A DeCant; Michael G Gibbs; Edward Chang; Xingruo Zhang; Andrew Y Cho; Nicholas J Beimer; Jerome Engel; Mark S Cohen; John M Stern Journal: Epilepsy Behav Date: 2020-11-13 Impact factor: 2.937
Authors: Wesley T Kerr; Emily A Janio; Chelsea T Braesch; Justine M Le; Jessica M Hori; Akash B Patel; Norma L Gallardo; Janar Bauirjan; Andrea M Chau; Eric S Hwang; Emily C Davis; Albert Buchard; David Torres-Barba; Shannon D'Ambrosio; Mona Al Banna; Andrew Y Cho; Jerome Engel; Mark S Cohen; John M Stern Journal: Epilepsy Behav Date: 2018-02-02 Impact factor: 2.937
Authors: Wesley T Kerr; Xingruo Zhang; Chloe E Hill; Emily A Janio; Andrea M Chau; Chelsea T Braesch; Justine M Le; Jessica M Hori; Akash B Patel; Corinne H Allas; Amir H Karimi; Ishita Dubey; Siddhika S Sreenivasan; Norma L Gallardo; Janar Bauirjan; Eric S Hwang; Emily C Davis; Shannon R D'Ambrosio; Mona Al Banna; Andrew Y Cho; Sandra R Dewar; Jerome Engel; Jamie D Feusner; John M Stern Journal: Seizure Date: 2021-02-15 Impact factor: 3.184
Authors: Wesley T Kerr; Xingruo Zhang; Chloe E Hill; Emily A Janio; Andrea M Chau; Chelsea T Braesch; Justine M Le; Jessica M Hori; Akash B Patel; Corinne H Allas; Amir H Karimi; Ishita Dubey; Siddhika S Sreenivasan; Norma L Gallardo; Janar Bauirjan; Eric S Hwang; Emily C Davis; Shannon R D'Ambrosio; Mona Al Banna; Andrew Y Cho; Sandra R Dewar; Jerome Engel; Jamie D Feusner; John M Stern Journal: Seizure Date: 2021-02-09 Impact factor: 3.184
Authors: Steven Lenio; Wesley T Kerr; Meagan Watson; Sarah Baker; Chad Bush; Alex Rajic; Laura Strom Journal: Epilepsy Behav Date: 2021-02-02 Impact factor: 2.937
Authors: Nicholas J Janocko; Jin Jing; Ziwei Fan; Diane L Teagarden; Hannah K Villarreal; Matthew L Morton; Olivia Groover; David W Loring; Daniel L Drane; M Brandon Westover; Ioannis Karakis Journal: Epilepsy Res Date: 2021-01-21 Impact factor: 3.045
Authors: John M Gledhill; Elizabeth J Brand; John R Pollard; Richard D St Clair; Todd M Wallach; Peter B Crino Journal: Neurology Date: 2021-01-25 Impact factor: 9.910
Authors: Wesley T Kerr; Xingruo Zhang; Emily A Janio; Amir H Karimi; Corinne H Allas; Ishita Dubey; Siddhika S Sreenivasan; Janar Bauirjan; Shannon R D'Ambrosio; Mona Al Banna; Andrew Y Cho; Jerome Engel; Mark S Cohen; Jamie D Feusner; John M Stern Journal: Epilepsy Behav Date: 2021-01-01 Impact factor: 2.937