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Epilepsy: Sensitivity and Specificity

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

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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