通过发作症状学诊断发作性疾病的可靠性

发布时间：2018-11-09 09:12

【摘要】：研究目的随着便携式摄像机的广泛普及,很多临床事件被记录并在就诊时提供给医生,这可以帮助医生更好的诊断。本研究旨在评估通过症状学诊断发作性疾病的可靠性,并分析其影响因素。研究方法从浙江大学附属第二医院癫痫中心选取50位病人,总共150个发作视频(每个病人三次相同类型的典型发作),这些视频包含了37癫痫性发作,8个器质性非癫痫性事件,5个心因性非癫痫性发作。共来自6家医院的8个癫痫专科医生,12个神经内科医生,10个内科医生通过观看发作期视频来判断是“癫痫性发作”还是“非癫痫性发作”,如果判断是“非癫痫性发作”,则还需要进行第二步,即判断是“心因性非癫痫性发作”还是“器质性非癫痫性事件”。研究结果所有发作类型的总体诊断准确率随观看发作的次数增多略有增加,从第一次观看发作时的61.4%逐渐增至66.0%(P0.001)。对于癫痫专科医生,其诊断的敏感性和特异性分别为77.0%和80.8%,明显高于神经内科医生(66.0%,69.9%)和内科医生(58.8%,65.8%)。不同发作类型的诊断准确率具有较大差异。全身强直阵挛的准确率高达89.5%,愣神发作和自动症发作的准确率分别为80.0%和76.0%,而肌阵挛发作(53.0%)、过度运动发作(48.1%)、痴笑／哭泣发作(43.8%)和心因性非癫痫性发作(43.0%)的准确率较低。研究结论观看更多的发作可以帮助提高发作性疾病的诊断准确率,并且发作类型及医生经验对诊断的准确率具有显著影响。此外,有必要对接诊发作性疾病的临床医生进行有关癫痫和非癫痫性发作的培训,例如,过度运动发作和心因性非癫痫性发作等“诊断困难的发作”。
[Abstract]:With the wide spread of camcorder, many clinical events are recorded and provided to doctors at the time of visit, which can help doctors to better diagnose. The purpose of this study was to assess the reliability of symptomatic diagnosis of paroxysmal diseases and to analyze its influencing factors. Methods Fifty patients were selected from the epilepsy center of the second affiliated Hospital of Zhejiang University for a total of 150 seizure videos (three typical seizures of the same type for each patient), which contained 37 epileptic seizures. 8 organic non-epileptic events and 5 psychogenic non-epileptic seizures. A total of 8 epileptic specialists, 12 neurologists and 10 physicians from 6 hospitals watched the video of the seizure to determine whether it was an "epileptic seizure" or a "non-epileptic seizure," if it was a "non-epileptic attack." The second step is to determine whether psychogenic non-epileptic seizures or organic non-epileptic events. Results the overall diagnostic accuracy of all seizure types increased slightly with the increase of the number of episodes, from 61.4% at the first episode to 66.0% (P0.001). The sensitivity and specificity of the diagnosis were 77.0% and 80.8%, respectively, which were significantly higher than those of the neurologist (66.0%) and the physician (58.8%). The diagnostic accuracy of different seizure types is different. The accuracy rate of generalized tonic-clonic clonus was as high as 89.5%, the accuracy rate of Leng seizure and automatic attack was 80.0% and 76.0% respectively, while myoclonic seizure (53.0%), hyperkinetic attack (48.1%), myoclonic seizure (53.0%), hyperkinetic seizure (48.1%), The accuracy of laugh / cry attack (43.8%) and psychogenic non-epileptic seizure (43.0%) was lower. Conclusion watching more seizures can help to improve the diagnostic accuracy of paroxysmal diseases, and the types of seizures and the experience of doctors have a significant impact on the accuracy of diagnosis. In addition, it is necessary to train clinicians in seizure and non-epileptic seizures, such as "difficult seizures" such as hyperkinetic seizures and psychogenic non-epileptic seizures.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R742.1

【相似文献】