Using interactional and linguistic analysis to distinguish between epileptic and psychogenic nonepileptic seizures: a prospective, blinded multirater study

Epilepsy Behav. 2009 Sep;16(1):139-44. doi: 10.1016/j.yebeh.2009.07.018. Epub 2009 Aug 11.


This study was carried out to test the suggestion that close interactional and linguistic examination of the communication between neurologists and patients during a first encounter can contribute to the differential diagnosis of epilepsy or psychogenic nonepileptic seizures. Twenty unselected patients admitted for video/EEG telemetry because of diagnostic uncertainty were included. Two linguists blinded to all medical data independently studied video recordings and transcripts of 25- to 35-minute interactions. They attempted to predict the medical diagnosis on the basis of qualitative assessments addressing 17 separate observations. They also used a diagnostic scoring aid (DSA) to convert their qualitative assessments into a simple numeric score. Using qualitative assessment, both linguists predicted 17 of 20 (85%) diagnoses (kappa=0.59). With the DSA, diagnoses were predicted with a sensitivity of 85.7% (71.4%) and a specificity of 84.6% (92.3%). This blinded, prospective multirater study confirms the diagnostic value of linguistic and interactional observations in the seizure clinic setting.

MeSH terms

  • Adult
  • Aged
  • Communication
  • Diagnosis, Differential
  • Electroencephalography
  • Epilepsy / diagnosis*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Observer Variation
  • Prospective Studies
  • Psycholinguistics
  • Reproducibility of Results
  • Seizures / diagnosis*