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Epilepsia. 2013 Aug;54(8):1402-8. doi: 10.1111/epi.12207. Epub 2013 May 3.

Time-frequency mapping of the rhythmic limb movements distinguishes convulsive epileptic from psychogenic nonepileptic seizures.

Author information

1
Department of Neurology, The Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, Victoria, Australia.

Abstract

PURPOSE:

A definite diagnosis of psychogenic nonepileptic seizures (PNES) usually requires in-patient video-electroencephalography (EEG) monitoring. Previous research has shown that convulsive psychogenic nonepileptic seizures (PNES) demonstrate a characteristic pattern of rhythmic movement artifact on the EEG. Herein we sought to examine the potential for time-frequency mapping of data from a movement-recording device (accelerometer) worn on the wrist as a diagnostic tool to differentiate between convulsive epileptic seizures and PNES.

METHODS:

Time-frequency mapping was performed on accelerometer traces obtained during 56 convulsive seizure-like events from 35 patients recorded during in-patient video-EEG monitoring. Twenty-six patients had PNES, eight had epileptic seizures, and one had both seizure types. The time-frequency maps were derived from fast Fourier transformations to determine the dominant frequency for sequential 2.56-s blocks for the course of each event.

KEY FINDINGS:

The coefficient of variation (CoV) of limb movement frequency for the PNES events was less than for the epileptic seizure events (median, 17.18% vs. 52.23%; p < 0.001). A blinded review of the time-frequency maps by an epileptologist was accurate in differentiating between the event types, that is, 38 (92.7%) of 41 and 6 (75%) of 8 nonepileptic and epileptic seizures, respectively, were diagnosed correctly, with seven events classified as "nondiagnostic." Using a CoV cutoff score of 32% resulted in similar classification accuracy, with 42 (93%) of 45 PNES and 10 (91%) of 11 epileptic seizure events correctly diagnosed.

SIGNIFICANCE:

Time-frequency analysis of data from a wristband movement monitor could be utilized as a diagnostic tool to differentiate between epileptic and nonepileptic convulsive seizure-like events.

KEYWORDS:

Epileptic seizures; Limb movements; Psychogenic nonepileptic seizures; Time-frequency mapping

PMID:
23647194
DOI:
10.1111/epi.12207
[Indexed for MEDLINE]
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