The Reprise Phenomenon: A Reliable Marker for Nonepileptic Spells
Abstract number :
G.06
Submission category :
Year :
2001
Submission ID :
2185
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
L.D. Uber-Zak, DO, Neurology, St. Josephs Hospital and Medical Center, Phoenix, AZ; D.E. Blum, MD, Neurology, St. Josephs Hospital and Medical Center, Phoenix, AZ; R.S. Fisher, MD, PhD, Neurology, Stanford University, Stanford, CA
RATIONALE: Discriminating non-epileptic spells (NES) or pseudoseizures from seizures clinically can present a difficult diagnostic dilemma. Few features are pathognomonic. We hypothesize that the reprise phenomena, which we define as an ictal motor behavior that starts, stops and then resumes during the course of an event, can be an accurate predictor of a diagnosis of NES.
METHODS: We restrospectively reviewed detailed descriptions of ictal behavior in 341 consecutive monitoring unit admissions over an 18 month period. Patients were included if they were between 18-60 years of age and had a final diagnosis of seizure or NES. Patients were excluded if they had a definable diagnosis other than seizure or NES (e.g. syncope, migraine, etc), a diagnosis of mixed seizures and NES, a nondiagnostic admission or were outside of the defined age range. A total of 256 patients were included, 127 with seizures and 129 with NES.
RESULTS: Reprise phenomena was seen almost exclusively in the patients with NES. The reprise phenomenon was seen in 42 of 129 patients (32.6%) with NES and 3 of 127 patients (2.4%) with seizures. Analysis with Chi-square resulted in a Chi-Square-Independence value of 40 with a p value of [lt] 0.0001.
CONCLUSIONS: The reprise phenomena is strongly predictive of NES. However, clinicians should remain vigilant for rare atypical instances of status epilepticus presenting with starts and stops.