Abstract
Therapy for convulsive seizures is usually initiated on the basis of clinical assessment, without video/EEG confirmation, but a nonepileptic origin may eventually be demonstrated. This study evaluates the diagnostic value of a witness-questionnaire in distinguishing between convulsive epileptic seizures (CES) and convulsive nonepileptic seizures (CNES).
We prospectively identified all adult patients admitted for video/EEG evaluation of convulsive attacks and interviewed the “best” witness using 12 questions on ictal and postictal features.
Video/EEG diagnosed CES in 19 and CNES in 26 patients. The predictive accuracy of the questionnaire was 84.4%. Six features were strong predictors of CNES diagnosis: ictal eye closure, presence of side-to-side movements, prolonged seizure duration, and three postictal breathing features (not loud, shallow, no snoring).
A structured witness questionnaire distinguishes CES and CNES and will help in selecting patients for early video/EEG evaluation and rapid initiation of appropriate therapy.
► Structured witness-questionnaire is helpful in distinguishing whether convulsions are epileptic or nonepileptic. ► The “best witness” is usually reliable in describing features. ► Highly predictive ictal features: eyes, side-to-side movements and seizure duration. ► Highly predictive postictal breathing: depth, loudness, and snoring. ► The SIPQ is a questionnaire with high predictive diagnostic accuracy.
