Document Detail

Value of tongue biting in the differential diagnosis between epileptic seizures and syncope.
MedLine Citation:
PMID:  22770819     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Tongue biting (TB) may occur both in epileptic seizures and in syncope. A comprehensive search of the literature to determine the accuracy of this physical finding and its prevalence in epileptic seizures and syncope is still lacking.
AIMS: To undertake a systematic review and a meta-analysis of studies evaluating the prevalence of TB in patients with epileptic seizures and syncope, and to determine sensitivity, specificity and likelihood ratios (LR) of this physical finding.
METHOD: Studies comparing the prevalence of TB in epileptic seizures and syncope were systematically searched. Prevalence of TB was analyzed calculating odds ratio (OR) with 95% confidence intervals (CIs). Sensitivity, specificity, positive and negative likelihood ratio (pLR, nLR) of TB were determined for each study and for the pooled results.
RESULTS: Two studies (75 epilepsy patients and 98 subjects with syncope) were included. There was a significantly higher prevalence of TB in patients with epileptic seizures (OR 12.26; 95% CI 3.99-37.69). Pooled accuracy measures of TB for the diagnosis of epileptic seizures were: sensitivity 33%, specificity 96%, pLR 8.167 (95% CI 2.969-22.461) and nLR 0.695 (95% CI 0.589-0.82).
CONCLUSIONS: A pooled analysis of data from the literature shows that TB has great value in the differential diagnosis between epileptic seizures and syncope. Given a certain pre-test probability of seizures, the presence of TB greatly increases the chance that the patient had an epileptic seizure. Systematic reviews with pooled analyses (meta-analyses) of data from the literature allow an increase in statistical power and an improvement in precision, representing a useful tool to determine the accuracy of a certain physical finding in the differential diagnosis between seizures and other paroxysmal events.
Francesco Brigo; Raffaele Nardone; Luigi Giuseppe Bongiovanni
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Publication Detail:
Type:  Journal Article; Review     Date:  2012-07-06
Journal Detail:
Title:  Seizure     Volume:  21     ISSN:  1532-2688     ISO Abbreviation:  Seizure     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-08-21     Completed Date:  2013-01-03     Revised Date:  2014-10-21    
Medline Journal Info:
Nlm Unique ID:  9306979     Medline TA:  Seizure     Country:  England    
Other Details:
Languages:  eng     Pagination:  568-72     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
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MeSH Terms
Diagnosis, Differential
Epilepsy / diagnosis*
Syncope / diagnosis*
Comment In:
Seizure. 2013 Nov;22(9):801   [PMID:  23743173 ]
Seizure. 2013 May;22(4):328   [PMID:  23385095 ]

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