Fevzi Yılmaz, Bedriye Muge Sonmez, Cemil Kavalci, Engin Deniz Arslan, Gulsum Caliskan, Inan Beydilli
{"title":"床边视神经鞘直径测量在急诊科鉴别诱发性癫痫与非诱发性癫痫的疗效。","authors":"Fevzi Yılmaz, Bedriye Muge Sonmez, Cemil Kavalci, Engin Deniz Arslan, Gulsum Caliskan, Inan Beydilli","doi":"10.5144/0256-4947.2023.42","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Emergency departments (EDs) are typically the first medical contact for seizure patients, and early diagnosis and treatment is primarily the responsibility of emergency physicians.</p><p><strong>Objectives: </strong>Demonstrate the efficacy of bedside ocular ultrasonography for optic nerve sheath diameter (ONSD) measurement in differentiating provoked seizure from unprovoked seizure in the ED.</p><p><strong>Design: </strong>Prospective observational study SETTINGS: Tertiary care hospital PATIENTS AND METHODS: Patients presenting to the ED with seizure were divided into two groups according to medical history, physical examination, laboratory results, cranial computed tomography findings and electroencephalography results. Patients with seizures that did not have a specific cause (unprovoked) were compared with patients who had seizures caused by underlying pathology (provoked). The measurement of the ONSD was taken at the bedside within 30 minutes of arrival. The study compared the ONSD values, age, sex, type of seizure, and Glasgow Coma Score between the two groups.</p><p><strong>Main outcome measure: </strong>Efficacy of ONSD to distinguish between provoked and unprovoked seizures.</p><p><strong>Sample size: </strong>210 patients RESULTS: One hundred and fourteen (54.3%) patients were in the provoked seizure group and 96 (45.7%) were in the unprovoked seizure group. The ONSD measurements were significantly higher in the provoked seizure group compared with the unprovoked seizure group (median 6.1 mm vs. 5.2 mm, <i>P</i><.001). The cut-off value of ONSD higher than 5.61 was significantly associated with the prediction of the provoked seizure (<i>P</i><.001). The area under the curve value was 0.882 (95% CI: 0.830-0.922) with a sensitivity of 86.5 and specificity of 78.9%.</p><p><strong>Conclusions: </strong>Bedside ONSD measurement by means of ocular ultrasound is an effective method for differentiating provoked seizure from unprovoked seizure.</p><p><strong>Limitations: </strong>Statistical significance of age on ONSD and exclusion of pediatric patients.</p><p><strong>Conflict of interest: </strong>None.</p>","PeriodicalId":8016,"journal":{"name":"Annals of Saudi Medicine","volume":"43 1","pages":"42-49"},"PeriodicalIF":1.5000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ee/55/0256-4947.2023.42.PMC9899342.pdf","citationCount":"1","resultStr":"{\"title\":\"Efficacy of bedside optic nerve sheath diameter measurement in differentiating provoked seizure from unprovoked seizure in the emergency department.\",\"authors\":\"Fevzi Yılmaz, Bedriye Muge Sonmez, Cemil Kavalci, Engin Deniz Arslan, Gulsum Caliskan, Inan Beydilli\",\"doi\":\"10.5144/0256-4947.2023.42\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Emergency departments (EDs) are typically the first medical contact for seizure patients, and early diagnosis and treatment is primarily the responsibility of emergency physicians.</p><p><strong>Objectives: </strong>Demonstrate the efficacy of bedside ocular ultrasonography for optic nerve sheath diameter (ONSD) measurement in differentiating provoked seizure from unprovoked seizure in the ED.</p><p><strong>Design: </strong>Prospective observational study SETTINGS: Tertiary care hospital PATIENTS AND METHODS: Patients presenting to the ED with seizure were divided into two groups according to medical history, physical examination, laboratory results, cranial computed tomography findings and electroencephalography results. Patients with seizures that did not have a specific cause (unprovoked) were compared with patients who had seizures caused by underlying pathology (provoked). The measurement of the ONSD was taken at the bedside within 30 minutes of arrival. The study compared the ONSD values, age, sex, type of seizure, and Glasgow Coma Score between the two groups.</p><p><strong>Main outcome measure: </strong>Efficacy of ONSD to distinguish between provoked and unprovoked seizures.</p><p><strong>Sample size: </strong>210 patients RESULTS: One hundred and fourteen (54.3%) patients were in the provoked seizure group and 96 (45.7%) were in the unprovoked seizure group. The ONSD measurements were significantly higher in the provoked seizure group compared with the unprovoked seizure group (median 6.1 mm vs. 5.2 mm, <i>P</i><.001). The cut-off value of ONSD higher than 5.61 was significantly associated with the prediction of the provoked seizure (<i>P</i><.001). The area under the curve value was 0.882 (95% CI: 0.830-0.922) with a sensitivity of 86.5 and specificity of 78.9%.</p><p><strong>Conclusions: </strong>Bedside ONSD measurement by means of ocular ultrasound is an effective method for differentiating provoked seizure from unprovoked seizure.</p><p><strong>Limitations: </strong>Statistical significance of age on ONSD and exclusion of pediatric patients.</p><p><strong>Conflict of interest: </strong>None.</p>\",\"PeriodicalId\":8016,\"journal\":{\"name\":\"Annals of Saudi Medicine\",\"volume\":\"43 1\",\"pages\":\"42-49\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2023-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ee/55/0256-4947.2023.42.PMC9899342.pdf\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Saudi Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5144/0256-4947.2023.42\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Saudi Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5144/0256-4947.2023.42","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 1
摘要
背景:急诊科(EDs)通常是癫痫患者的第一个医疗接触，早期诊断和治疗是急诊医生的主要责任。目的:证明床边眼超声测量视神经鞘直径(ONSD)在鉴别ed诱发性癫痫发作和非诱发性癫痫发作中的作用。设计:前瞻性观察研究设置:三级医院患者和方法:根据病史、体格检查、实验室检查结果、颅脑ct及脑电图结果将出现癫痫发作的ED患者分为两组。没有特定原因(非诱发)的癫痫发作患者与由潜在病理(诱发)引起的癫痫发作患者进行比较。在患者到达后30分钟内在床边测量ONSD。该研究比较了两组患者的ONSD值、年龄、性别、癫痫发作类型和格拉斯哥昏迷评分。主要结局指标:ONSD区分诱发性和非诱发性癫痫发作的疗效。结果:诱发性癫痫发作组114例(54.3%)，非诱发性癫痫发作组96例(45.7%)。诱发性癫痫发作组的ONSD测量值明显高于非诱发性癫痫发作组(中位值6.1 mm vs. 5.2 mm, ppp)。结论:通过眼超声床边ONSD测量是鉴别诱发性癫痫发作与非诱发性癫痫发作的有效方法。局限性:年龄对ONSD有统计学意义，排除儿科患者。利益冲突:无。
Efficacy of bedside optic nerve sheath diameter measurement in differentiating provoked seizure from unprovoked seizure in the emergency department.
Background: Emergency departments (EDs) are typically the first medical contact for seizure patients, and early diagnosis and treatment is primarily the responsibility of emergency physicians.
Objectives: Demonstrate the efficacy of bedside ocular ultrasonography for optic nerve sheath diameter (ONSD) measurement in differentiating provoked seizure from unprovoked seizure in the ED.
Design: Prospective observational study SETTINGS: Tertiary care hospital PATIENTS AND METHODS: Patients presenting to the ED with seizure were divided into two groups according to medical history, physical examination, laboratory results, cranial computed tomography findings and electroencephalography results. Patients with seizures that did not have a specific cause (unprovoked) were compared with patients who had seizures caused by underlying pathology (provoked). The measurement of the ONSD was taken at the bedside within 30 minutes of arrival. The study compared the ONSD values, age, sex, type of seizure, and Glasgow Coma Score between the two groups.
Main outcome measure: Efficacy of ONSD to distinguish between provoked and unprovoked seizures.
Sample size: 210 patients RESULTS: One hundred and fourteen (54.3%) patients were in the provoked seizure group and 96 (45.7%) were in the unprovoked seizure group. The ONSD measurements were significantly higher in the provoked seizure group compared with the unprovoked seizure group (median 6.1 mm vs. 5.2 mm, P<.001). The cut-off value of ONSD higher than 5.61 was significantly associated with the prediction of the provoked seizure (P<.001). The area under the curve value was 0.882 (95% CI: 0.830-0.922) with a sensitivity of 86.5 and specificity of 78.9%.
Conclusions: Bedside ONSD measurement by means of ocular ultrasound is an effective method for differentiating provoked seizure from unprovoked seizure.
Limitations: Statistical significance of age on ONSD and exclusion of pediatric patients.
期刊介绍：
The Annals of Saudi Medicine (ASM) is published bimonthly by King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. We publish scientific reports of clinical interest in English. All submissions are subject to peer review by the editorial board and by reviewers in appropriate specialties. The journal will consider for publication manuscripts from any part of the world, but particularly reports that would be of interest to readers in the Middle East or other parts of Asia and Africa. Please go to the Author Resource Center for additional information.
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