Epilepsy: Sensitivity and Specificity

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

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Differential Diagnoses include: Syncope

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

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Sensitive Findings
Finding	Result	Sensitivity	Specificity
[ + ] Postictal Confusion	+ 0 -	94%	69%
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Abnormal Behavior	+ 0 -	92%	67%
noted by bystanders Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268

Poorly Diagnostic Findings
Finding	Result	Sensitivity	Specificity
[ + ] Postictal Headache	+ 0 -	49%	83%
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Unresponsiveness	+ 0 -	77%	75%
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268

Specific Findings
Finding	Result	Sensitivity	Specificity
[ + ] Interictal EEG	+ 0 -	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	+ 0 -	7.8%	98.2%
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Prodromal Hallucinations	+ 0 -	8%	98%
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Cut Tongue	+ 0 -	45%	97%
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Head Turning	+ 0 -	43%	97%
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Unusual Posturing	+ 0 -	35%	97%
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Interictal EEG	+ 0 -	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	+ 0 -	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	+ 0 -	23%	96%
aka "bedwetting" Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Prodromal Deja Vu	+ 0 -	14%	96%
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Myalgia	+ 0 -	16%	95%
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Cyanosis	+ 0 -	33%	94%
observed by bystanders Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Prodromal Trembling	+ 0 -	29%	94%
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Limb Jerking	+ 0 -	69%	88%
noted by bystanders Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Chest Pain	+ 0 -	2%	87.2%
presyncopal Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Amnesia	+ 0 -	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	+ 0 -	3.9%	86.3%
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Provoked by Stress	+ 0 -	57%	85%
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268

Negative Findings
Finding	Result	Sensitivity	Specificity
[ + ] Chest Pain	+ 0 -	2%	87.2%
presyncopal Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Presyncope with Needle	+ 0 -	3.9%	86.3%
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Vertigo	+ 0 -	5.9%	78.5%
prodromal Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Presyncopal Dyspnea	+ 0 -	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	+ 0 -	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	+ 0 -	7.8%	73.1%
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Presyncopal Nausea	+ 0 -	5.9%	72.2%
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Hypertension	+ 0 -	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	+ 0 -	9.8%	69%
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Presyncope with Standing	+ 0 -	5.9%	67.6%
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Palpitations	+ 0 -	3.9%	66.2%
presyncopal Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Presyncopal Warmth	+ 0 -	7.8%	66.2%
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Presyncopal Diaphoresis	+ 0 -	5.9%	65.3%
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Syncope with Standing	+ 0 -	2%	60%
(history of) Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Chest Pain	+ 0 -	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	+ 0 -	11.8%	42.5%
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Presyncopal Episodes	+ 0 -	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	+ 0 -	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