Affiliation:
1. Stichting Epilepsie Instellingen Nederland (SEIN) Heemstede the Netherlands
2. Medische Kliniek Velsen Velsen‐Noord the Netherlands
3. Department of Cardiology Amsterdam University Medical Center Amsterdam the Netherlands
4. UCL Queen Square Institute of Neurology and Chalfont Centre for Epilepsy London UK
5. Department of Neurology, West China Hospital Sichuan University Chengdu China
6. Department of Neurology Leiden University Medical Center Leiden the Netherlands
Abstract
AbstractObjectiveThis study was undertaken to develop a model and perform a preliminary internal validation study of the Scale for Objective Diagnostic Components of Paroxysmal Events (STAMP).MethodsWe developed STAMP, which builds on the International League Against Epilepsy task force scale for functional seizures with additional categories for epileptic seizures and syncope. We included 200 consecutive referrals to a Dutch tertiary epilepsy center to evaluate seizurelike events. We recorded demographic and clinical data and collected the clinical evaluation at referral and after 3, 6, 9, and 12 months of follow‐up. We ascertained the STAMP at each time point and evaluated factors predicting an improvement in STAMP grade during follow‐up.ResultsOf the 200 referrals at baseline, 131 were classified as having epileptic seizures, 17 as functional seizures, and three as syncope, and 49 were unclassifiable. STAMP grade at baseline was 4 (absent) in 56 individuals, 3 (circumstantial) in 78, 2 (clinically established) in six, and 1 (documented) in 11. Over time, 62 cases STAMP grades improved, and 23 remained unclassifiable. A refinement of STAMP grade during follow‐up was due to successful event recordings in 34 people (30 video‐electroencephalographic [EEG] recordings, four tilt table testing), home videos or clinician‐witnessed events in 13, and identification of interictal EEG or magnetic resonance imaging abnormalities in seven. An improved STAMP grade after 12 months of follow‐up was significantly more likely in those with higher event frequency, unclassifiable events, longer event duration, and a shorter time since the first event and less likely in those with a history suggestive of seizures.SignificanceThis epilepsy service evaluation underscores the crucial role of event recording in improving diagnostic certainty. STAMP may be used to monitor diagnostic performance over time but requires further validation.