30 Nov 2009
Pioneering research undertaken at the University of Sheffield has revealed that linguistic observations can help doctors differentiate between two of the most common causes of blackouts.
The news comes within National Epilepsy Month, which aims to raise awareness about epilepsy and promote tolerance and overall understanding of the condition.
The sociolinguistic study at the University, breaks completely new ground. Led by Markus Reuber, senior clinical lecturer and honorary consultant in the Academic Neurology Unit at the University of Sheffield, this is the first time conversation analysis has been shown to be capable of making a contribution to the differential diagnosis of superficially similar disorders.
The correct treatment of seizure disorders like epilepsy crucially depends on getting the diagnosis right. The three commonest causes of blackouts (epilepsy, fainting and non-epileptic attack disorder) require very different treatments. Whilst it is relatively easy to distinguish between epilepsy and fainting, it is very difficult to differentiate between epilepsy and non-epileptic attacks (NEA). Prior to this study, misdiagnosis frequencies of between 5 per cent and 50 per cent have been reported.
Epileptic seizures occur due to self-limited activity of neurons in the brain, characterised by recurrent epileptic seizures, while NEA are episodes of loss of control not associated with electrical discharges in the brain. Instead, NEA occur in response to distressing situations, sensations, emotions, thoughts or memories when alternative coping mechanisms are inadequate or have been overwhelmed. The treatment of choice for epilepsy involves antiepileptic drugs, while the first line treatment of NEA would be psychotherapy.
Researchers at the University independently analysed twenty first 30-minute doctor-patient encounters and focused on how patients with epilepsy and NEA talked to their doctor about their seizures, rather than what symptoms they mentioned. In these patients, the correct diagnosis had been proven by the simultaneous video and brainwave recording of a typical seizure. The study concentrated on aspects of the consultation which might otherwise be considered redundant by the doctor, such as the patient's willingness to volunteer information about their seizure experience, evidence of hesitation and reformulations of the information they were sharing with the doctor. These features proved very different between patients with epilepsy and NEA.
The findings showed that the patients with epilepsy tend to volunteer detailed first person accounts of seizures. In contrast, patients with NEA tend to resist focusing on individual seizure episodes and only provided seizure descriptions after repeated prompting by the doctor.
As a result, Markus Reuber and his team were able to correctly distinguish non-epileptic from epileptic seizures in 17 out of 20 cases, just by analysing the linguistic content of the transcript. It is now hoped that the groundbreaking research will allow patients to be more accurately diagnosed, as prior to this study, only 40 per cent of the patients investigated carried the correct diagnosis and received appropriate treatment.
Markus Reuber, senior clinical lecturer and honorary consultant in the Academic Neurology Unit at the University of Sheffield, said: "Neurologists see patients with epilepsy and non-epileptic attacks every week. The differentiation of epileptic and non-epileptic attacks is one of the most challenging tasks in the neurology outpatient clinic.
"This work does not only help neurologists with this difficult problem but also enables them to understand patients and their seizure experiences much better. I apply the insights I have gained from this research in my daily practice."
Dr Chiara M. Monzoni, linguist and post-doctoral research associate from the Academic Neurology Unit at the University of Sheffield, said: "Doctor-patient interaction has always been investigated through conversation analysis in order to understand how activities like decision making, diagnosis delivery or advice of treatment are actualized in interaction, in order for doctors to improve their daily practice.
"This study instead demonstrates that conversation analysis can help doctors in diagnostic processes which might be particularly challenging. It could be applied also to other difficult conditions as: anxiety/depression, headache/migraines, pain and amnesia so is particularly groundbreaking."
Source
University of Sheffield
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Article URL: http://www.medicalnewstoday.com/articles/172397.php
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