目的:本研究旨在建立一个模型,并对阵发性事件客观诊断成分量表(STAMP)进行初步内部验证研究。
方法:我们开发了STAMP,它建立在国际抗癫痫联盟特别工作组功能性癫痫发作量表的基础上,并增加了癫痫发作和晕厥的类别。我们纳入了荷兰三级癫痫中心的200例连续转诊,以评估癫痫样事件。我们记录了人口统计学和临床数据,并收集了转诊时以及随访3、6、9和12个月后的临床评估。我们确定了每个时间点的STAMP,并评估了预测随访期间STAMP等级改善的因素。
结果:在基线时的200次转诊中,131人被归类为癫痫发作,17作为功能性癫痫发作,三个是晕厥,49个是无法分类的。56个人的基线STAMP等级为4(不存在),78人中有3人(间接),6人中有2人(临床确定),和11中的1个(记录在案)。随着时间的推移,62例STAMP成绩提高,23仍然无法分类。随访期间STAMP等级的提高是由于34人的成功事件记录(30视频脑电图[EEG]记录,四个倾斜台测试),家庭录像或临床医生见证的事件在13,和识别发作间期脑电图或磁共振成像异常在7。在12个月的随访后,STAMP等级的改善在事件频率较高的患者中更有可能。不可分类的事件,事件持续时间较长,并且自第一次事件以来的时间较短,并且在有癫痫发作病史的人中的可能性较小。
结论:这项癫痫服务评估强调了事件记录在提高诊断确定性方面的关键作用。STAMP可用于随时间监控诊断性能,但需要进一步验证。
OBJECTIVE: This study was undertaken to develop a model and perform a preliminary internal validation study of the Scale for Objective Diagnostic Components of Paroxysmal Events (STAMP).
METHODS: We developed STAMP, which builds on the International League Against Epilepsy task force scale for functional seizures with additional categories for epileptic seizures and
syncope. We included 200 consecutive referrals to a Dutch tertiary epilepsy center to evaluate seizurelike events. We recorded demographic and clinical data and collected the clinical evaluation at referral and after 3, 6, 9, and 12 months of follow-up. We ascertained the STAMP at each time point and evaluated factors predicting an improvement in STAMP grade during follow-up.
RESULTS: Of the 200 referrals at baseline, 131 were classified as having epileptic seizures, 17 as functional seizures, and three as
syncope, and 49 were unclassifiable. STAMP grade at baseline was 4 (absent) in 56 individuals, 3 (circumstantial) in 78, 2 (clinically established) in six, and 1 (documented) in 11. Over time, 62 cases STAMP grades improved, and 23 remained unclassifiable. A refinement of STAMP grade during follow-up was due to successful event recordings in 34 people (30 video-electroencephalographic [EEG] recordings, four tilt table testing), home videos or clinician-witnessed events in 13, and identification of interictal EEG or magnetic resonance imaging abnormalities in seven. An improved STAMP grade after 12 months of follow-up was significantly more likely in those with higher event frequency, unclassifiable events, longer event duration, and a shorter time since the first event and less likely in those with a history suggestive of seizures.
CONCLUSIONS: This epilepsy service evaluation underscores the crucial role of event recording in improving diagnostic certainty. STAMP may be used to monitor diagnostic performance over time but requires further validation.