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Epilepsy: Sensitivity and Specificity

Introduction: aka seizure. See also Syncope as a differential diagnosis.

[Edit Diagnosis] [Merge dx] [Add prevalence]

Tags: Neurologic Tag this Diagnosis.

Differential Diagnoses include: Syncope

The sensitivity and specificity of findings for Epilepsy are listed below. See the left navigation bar to change the display.

Specific Findings

Finding SensitivitySpecificity Comments, Study
Interictal EEG
Duplicate Edit		 29%99.5%

EEG findings are spikes or sharp waves, most often at the epileptogenic focus.

Sensitivity may be as high as 50% (depending on the study). Serial EEGs increase sensitivity up to 92% by 4 studies in one referenced case series.

Study: Epilepsia. 2006;47 Suppl 1:14-22. PMID: 17044820

Epilepsia. 1987 Jul-Aug;28(4):331-4. PMID: 3622408
Prodromal Preoccupation Edit 7.8%98.2%

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Prodromal Hallucinations Edit 8%98%

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Cut Tongue Edit 45%97%

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Head Turning Edit 43%97%

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Unusual Posturing Edit 35%97%

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Interictal EEG
Duplicate Edit		 50%96%

Paper in Portuguese. Not read in full. Sensitivity 50-55%, upper limit of specificity 96%.

Study: Acta Med Port. 2004 Nov-Dec;17(6):465-70. Epub 2005 Jan 18. PMID: 16197858

Elevated Prolactin Edit 46%96%

within 10-20min after event. This is for complex partial. Sensitivity up to 60% with generalized tonic-clonic.

Study: Neurology. 2005 Sep 13;65(5):668-75. PMID: 16157897

Urinary Incontinence Edit 23%96%

aka "bedwetting"

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Prodromal Deja Vu Edit 14%96%

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Myalgia Edit 16%95%

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Cyanosis Edit 33%94%

observed by bystanders

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Prodromal Trembling Edit 29%94%

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Limb Jerking Edit 69%88%

noted by bystanders

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Chest Pain
Duplicate Edit		 2%87.2%

presyncopal

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Amnesia Edit 53%87%

i.e. does not recall behavior during event

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Presyncope with Needle Edit 3.9%86.3%

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Provoked by Stress Edit 57%85%

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268

Sensitive Findings

Finding SensitivitySpecificity Comments, Study
Postictal Confusion Edit 94%69%

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Abnormal Behavior Edit 92%67%

noted by bystanders

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268

Negative Findings

Finding SensitivitySpecificity Comments, Study
Chest Pain
Duplicate Edit		 2%87.2%

presyncopal

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Presyncope with Needle Edit 3.9%86.3%

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Vertigo Edit 5.9%78.5%

prodromal

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Presyncopal Dyspnea Edit 2%76.3%

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
History of Coronary Artery Disease Edit 2%74.9%

(history of)

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Presyncope with Heat Edit 7.8%73.1%

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Presyncopal Nausea Edit 5.9%72.2%

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Hypertension Edit 7.8%70.8%

physician-measured

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Self-Reported High Blood Pressure Edit 9.8%69%

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Presyncope with Standing Edit 5.9%67.6%

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Palpitations Edit 3.9%66.2%

presyncopal

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Presyncopal Warmth Edit 7.8%66.2%

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Presyncopal Diaphoresis Edit 5.9%65.3%

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Syncope with Standing Edit 2%60%

(history of)

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Chest Pain
Duplicate Edit		 9.8%54.3%

ever

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Remembered Loss of Consciousness Edit 11.8%42.5%

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Presyncopal Episodes
Duplicate Edit		 27.5%27.4%

before actual syncope, by history

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Presyncopal Episodes
Duplicate Edit		 23.5%13.7%

ever / of any type

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268

Poorly Diagnostic Findings

Finding SensitivitySpecificity Comments, Study
Postictal Headache Edit 49%83%

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
Unresponsiveness Edit 77%75%

Differential Diagnosis: Syncope

Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268

 

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