Epilepsy: Likelihood Ratios

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

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Differential Diagnoses include: Syncope

The likelihood ratios 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.)

Good Positive and Negative Likelihood Ratios
Finding	Result	+LR	-LR
[ + ] Postictal Confusion	+ 0 -	3	0.1
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Abnormal Behavior	+ 0 -	2.8	0.1
noted by bystanders Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Unresponsiveness	+ 0 -	3.1	0.3
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Limb Jerking	+ 0 -	5.8	0.4
noted by bystanders Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Interictal EEG	+ 0 -	12.5	0.5
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
[ + ] Amnesia	+ 0 -	4.1	0.5
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
[ + ] Provoked by Stress	+ 0 -	3.8	0.5
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268

Good Positive Likelihood Ratio
Finding	Result	+LR	-LR
[ + ] Interictal EEG	+ 0 -	58	0.7
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
[ + ] Cut Tongue	+ 0 -	15	0.6
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Head Turning	+ 0 -	14.3	0.6
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Unusual Posturing	+ 0 -	11.7	0.7
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Elevated Prolactin	+ 0 -	11.5	0.6
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 -	5.8	0.8
aka "bedwetting" Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Cyanosis	+ 0 -	5.5	0.7
observed by bystanders Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Prodromal Trembling	+ 0 -	4.8	0.8
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Prodromal Preoccupation	+ 0 -	4.3	0.9
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Prodromal Hallucinations	+ 0 -	4	0.9
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Prodromal Deja Vu	+ 0 -	3.5	0.9
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Myalgia	+ 0 -	3.2	0.9
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Postictal Headache	+ 0 -	2.9	0.6
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268

Negative Findings
Finding	Result	+LR	-LR
[ + ] Palpitations	+ 0 -	0.1	1.5
presyncopal Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Presyncopal Dyspnea	+ 0 -	0.1	1.3
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] History of Coronary Artery Disease	+ 0 -	0.1	1.3
(history of) Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Syncope with Standing	+ 0 -	0.1	1.6
(history of) Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Presyncopal Warmth	+ 0 -	0.2	1.4
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Chest Pain	+ 0 -	0.2	1.7
ever Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Presyncopal Nausea	+ 0 -	0.2	1.3
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Remembered Loss of Consciousness	+ 0 -	0.2	2.1
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Presyncope with Standing	+ 0 -	0.2	1.4
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Presyncopal Diaphoresis	+ 0 -	0.2	1.4
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Chest Pain	+ 0 -	0.2	1.1
presyncopal Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Self-Reported High Blood Pressure	+ 0 -	0.3	1.3
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Presyncope with Heat	+ 0 -	0.3	1.3
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Presyncope with Needle	+ 0 -	0.3	1.1
Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Vertigo	+ 0 -	0.3	1.2
prodromal Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Presyncopal Episodes	+ 0 -	0.3	5.6
ever / of any type Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Hypertension	+ 0 -	0.3	1.3
physician-measured Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268
[ + ] Presyncopal Episodes	+ 0 -	0.4	2.6
before actual syncope, by history Differential Diagnosis: Syncope Study: J Am Coll Cardiol. 2002 Jul 3;40(1):142-8. PMID: 12103268