The role of the electroencephalogram (EEG) in determining the aetiology of catatonia: a systematic review and meta-analysis of diagnostic test accuracyResearch in context
Summary: Background: Catatonia is a psychomotor syndrome that has a wide range of aetiologies. Determining whether catatonia is due to a medical or psychiatric cause is important for directing treatment but is clinically challenging. We aimed to ascertain the performance of the electroencephalogram...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-02-01
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| Series: | EClinicalMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537022005375 |
| _version_ | 1797895527901167616 |
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| author | Paris Hosseini Rebecca Whincup Karrish Devan Dory Anthony Ghanem Jack B. Fanshawe Aman Saini Benjamin Cross Apoorva Vijay Tomas Mastellari Umesh Vivekananda Steven White Franz Brunnhuber Michael S. Zandi Anthony S. David Ben Carter Dominic Oliver Glyn Lewis Charles Fry Puja R. Mehta Biba Stanton Jonathan P. Rogers |
| author_facet | Paris Hosseini Rebecca Whincup Karrish Devan Dory Anthony Ghanem Jack B. Fanshawe Aman Saini Benjamin Cross Apoorva Vijay Tomas Mastellari Umesh Vivekananda Steven White Franz Brunnhuber Michael S. Zandi Anthony S. David Ben Carter Dominic Oliver Glyn Lewis Charles Fry Puja R. Mehta Biba Stanton Jonathan P. Rogers |
| author_sort | Paris Hosseini |
| collection | DOAJ |
| description | Summary: Background: Catatonia is a psychomotor syndrome that has a wide range of aetiologies. Determining whether catatonia is due to a medical or psychiatric cause is important for directing treatment but is clinically challenging. We aimed to ascertain the performance of the electroencephalogram (EEG) in determining whether catatonia has a medical or psychiatric cause, conventionally defined. Methods: In this systematic review and meta-analysis of diagnostic test accuracy (PROSPERO CRD42021239027), Medline, EMBASE, PsycInfo, and AMED were searched from inception to May 11, 2022 for articles published in peer-reviewed journals that reported EEG findings in catatonia of a medical or psychiatric origin and were reported in English, French, or Italian. Eligible study types were clinical trials, cohort studies, case–control studies, cross-sectional studies, case series, and case reports. The reference standard was the final clinical diagnosis. Data extraction was conducted using individual patient-level data, where available, by two authors. We prespecified two types of studies to overcome the limitations anticipated in the data: larger studies (n ≥ 5), which were suitable for formal meta-analytic methods but generally lacked detailed information about participants, and smaller studies (n < 5), which were unsuitable for formal meta-analytic methods but had detailed individual patient level data, enabling additional sensitivity analyses. Risk of bias and applicability were assessed with the QUADAS-2 tool for larger studies, and with a published tool designed for case reports and series for smaller studies. The primary outcomes were sensitivity and specificity, which were derived using a bivariate mixed-effects regression model. Findings: 355 studies were included, spanning 707 patients. Of the 12 larger studies (5 cohort studies and 7 case series), 308 patients were included with a mean age of 48.2 (SD = 8.9) years. 85 (52.8%) were reported as male and 99 had catatonia due to a general medical condition. In the larger studies, we found that an abnormal EEG predicted a medical cause of catatonia with a sensitivity of 0.82 (95% CI 0.67–0.91) and a specificity of 0.66 (95% CI 0.45–0.82) with an I2 of 74% (95% CI 42–100%). The area under the summary ROC curve offered excellent discrimination (AUC = 0.83). The positive likelihood ratio was 2.4 (95% CI 1.4–4.1) and the negative likelihood ratio was 0.28 (95% CI 0.15–0.51). Only 5 studies had low concerns in terms of risk of bias and applicability, but a sensitivity analysis limited to these studies was similar to the main analysis. Among the 343 smaller studies, 399 patients were included, resulting in a sensitivity of 0.76 (95% CI 0.71–0.81), specificity of 0.67 (0.57–0.76) and AUC = 0.71 (95% CI 0.67–0.76). In multiple sensitivity analyses, the results were robust to the exclusion of reports of studies and individuals considered at high risk of bias. Features of limbic encephalitis, epileptiform discharges, focal abnormality, or status epilepticus were highly specific to medical catatonia, but features of encephalopathy had only moderate specificity and occurred in 23% of the cases of psychiatric catatonia in smaller studies. Interpretation: In cases of diagnostic uncertainty, the EEG should be used alongside other investigations to ascertain whether the underlying cause of catatonia is medical. The main limitation of this review is the differing thresholds for considering an EEG abnormal between studies. Funding: Wellcome Trust, NIHR Biomedical Research Centre at University College London Hospitals NHS Foundation Trust. |
| first_indexed | 2024-04-10T07:27:15Z |
| format | Article |
| id | doaj.art-24da5b696f3f4f7e9227c000a6761a8d |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-04-10T07:27:15Z |
| publishDate | 2023-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-24da5b696f3f4f7e9227c000a6761a8d2023-02-24T04:31:18ZengElsevierEClinicalMedicine2589-53702023-02-0156101808The role of the electroencephalogram (EEG) in determining the aetiology of catatonia: a systematic review and meta-analysis of diagnostic test accuracyResearch in contextParis Hosseini0Rebecca Whincup1Karrish Devan2Dory Anthony Ghanem3Jack B. Fanshawe4Aman Saini5Benjamin Cross6Apoorva Vijay7Tomas Mastellari8Umesh Vivekananda9Steven White10Franz Brunnhuber11Michael S. Zandi12Anthony S. David13Ben Carter14Dominic Oliver15Glyn Lewis16Charles Fry17Puja R. Mehta18Biba Stanton19Jonathan P. Rogers20Department of Neuropsychiatry, University College London Hospitals NHS Foundation Trust, London, UKLeicestershire Partnership NHS Trust, Leicester, UKSouth London and Maudsley NHS Foundation Trust, London, UKMedical School, University College London, London, UKDepartment of Psychiatry, University of Oxford, Oxford, UKMedical School, University College London, London, UKMersey Care NHS Foundation Trust, Prescot, UKGKT School of Medical Education, King's College London, London, UKDivision of Psychiatry, University College London, London, UK; Inserm U1172, CHU de Lille, Lille Neuroscience & Cognition (LilNCog), Université de Lille, Lille, FranceDepartment of Clinical and Experimental Epilepsy, Institute of Neurology UCL, London, UK; National Hospital for Neurology and Neurosurgery, London, UKDepartment of Clinical Neurophysiology, The National Hospital for Neurology and Neurosurgery, London, UKDepartment of Clinical Neurophysiology, King's College Hospital NHS Foundation Trust, London, UKNational Hospital for Neurology and Neurosurgery, London, UK; Queen Square Institute of Neurology, University College London, London, UKInstitute of Mental Health, University College London, London, UKDepartment of Biostatistics and Health Informatics, King's College London, London, UKDepartment of Psychosis Studies, King's College London, London, UKDivision of Psychiatry, University College London, London, UKDepartment of Clinical Neurophysiology, King's College Hospital NHS Foundation Trust, London, UKQueen Square Institute of Neurology, University College London, London, UKDepartment of Neurology, King's College Hospital NHS Foundation Trust, London, UK; Neuropsychiatry Service, South London and Maudsley NHS Trust, St. Thomas' Hospital, London, UKSouth London and Maudsley NHS Foundation Trust, London, UK; Division of Psychiatry, University College London, London, UK; Corresponding author. UCL Division of Psychiatry, 6th Floor, Maple House, 149 Tottenham Court Rd, Bloomsbury, London W1T 7NF, UK.Summary: Background: Catatonia is a psychomotor syndrome that has a wide range of aetiologies. Determining whether catatonia is due to a medical or psychiatric cause is important for directing treatment but is clinically challenging. We aimed to ascertain the performance of the electroencephalogram (EEG) in determining whether catatonia has a medical or psychiatric cause, conventionally defined. Methods: In this systematic review and meta-analysis of diagnostic test accuracy (PROSPERO CRD42021239027), Medline, EMBASE, PsycInfo, and AMED were searched from inception to May 11, 2022 for articles published in peer-reviewed journals that reported EEG findings in catatonia of a medical or psychiatric origin and were reported in English, French, or Italian. Eligible study types were clinical trials, cohort studies, case–control studies, cross-sectional studies, case series, and case reports. The reference standard was the final clinical diagnosis. Data extraction was conducted using individual patient-level data, where available, by two authors. We prespecified two types of studies to overcome the limitations anticipated in the data: larger studies (n ≥ 5), which were suitable for formal meta-analytic methods but generally lacked detailed information about participants, and smaller studies (n < 5), which were unsuitable for formal meta-analytic methods but had detailed individual patient level data, enabling additional sensitivity analyses. Risk of bias and applicability were assessed with the QUADAS-2 tool for larger studies, and with a published tool designed for case reports and series for smaller studies. The primary outcomes were sensitivity and specificity, which were derived using a bivariate mixed-effects regression model. Findings: 355 studies were included, spanning 707 patients. Of the 12 larger studies (5 cohort studies and 7 case series), 308 patients were included with a mean age of 48.2 (SD = 8.9) years. 85 (52.8%) were reported as male and 99 had catatonia due to a general medical condition. In the larger studies, we found that an abnormal EEG predicted a medical cause of catatonia with a sensitivity of 0.82 (95% CI 0.67–0.91) and a specificity of 0.66 (95% CI 0.45–0.82) with an I2 of 74% (95% CI 42–100%). The area under the summary ROC curve offered excellent discrimination (AUC = 0.83). The positive likelihood ratio was 2.4 (95% CI 1.4–4.1) and the negative likelihood ratio was 0.28 (95% CI 0.15–0.51). Only 5 studies had low concerns in terms of risk of bias and applicability, but a sensitivity analysis limited to these studies was similar to the main analysis. Among the 343 smaller studies, 399 patients were included, resulting in a sensitivity of 0.76 (95% CI 0.71–0.81), specificity of 0.67 (0.57–0.76) and AUC = 0.71 (95% CI 0.67–0.76). In multiple sensitivity analyses, the results were robust to the exclusion of reports of studies and individuals considered at high risk of bias. Features of limbic encephalitis, epileptiform discharges, focal abnormality, or status epilepticus were highly specific to medical catatonia, but features of encephalopathy had only moderate specificity and occurred in 23% of the cases of psychiatric catatonia in smaller studies. Interpretation: In cases of diagnostic uncertainty, the EEG should be used alongside other investigations to ascertain whether the underlying cause of catatonia is medical. The main limitation of this review is the differing thresholds for considering an EEG abnormal between studies. Funding: Wellcome Trust, NIHR Biomedical Research Centre at University College London Hospitals NHS Foundation Trust.http://www.sciencedirect.com/science/article/pii/S2589537022005375CatatoniaElectroencephalogramEEGSystematic reviewMeta-analysisDiagnostic test accuracy |
| spellingShingle | Paris Hosseini Rebecca Whincup Karrish Devan Dory Anthony Ghanem Jack B. Fanshawe Aman Saini Benjamin Cross Apoorva Vijay Tomas Mastellari Umesh Vivekananda Steven White Franz Brunnhuber Michael S. Zandi Anthony S. David Ben Carter Dominic Oliver Glyn Lewis Charles Fry Puja R. Mehta Biba Stanton Jonathan P. Rogers The role of the electroencephalogram (EEG) in determining the aetiology of catatonia: a systematic review and meta-analysis of diagnostic test accuracyResearch in context EClinicalMedicine Catatonia Electroencephalogram EEG Systematic review Meta-analysis Diagnostic test accuracy |
| title | The role of the electroencephalogram (EEG) in determining the aetiology of catatonia: a systematic review and meta-analysis of diagnostic test accuracyResearch in context |
| title_full | The role of the electroencephalogram (EEG) in determining the aetiology of catatonia: a systematic review and meta-analysis of diagnostic test accuracyResearch in context |
| title_fullStr | The role of the electroencephalogram (EEG) in determining the aetiology of catatonia: a systematic review and meta-analysis of diagnostic test accuracyResearch in context |
| title_full_unstemmed | The role of the electroencephalogram (EEG) in determining the aetiology of catatonia: a systematic review and meta-analysis of diagnostic test accuracyResearch in context |
| title_short | The role of the electroencephalogram (EEG) in determining the aetiology of catatonia: a systematic review and meta-analysis of diagnostic test accuracyResearch in context |
| title_sort | role of the electroencephalogram eeg in determining the aetiology of catatonia a systematic review and meta analysis of diagnostic test accuracyresearch in context |
| topic | Catatonia Electroencephalogram EEG Systematic review Meta-analysis Diagnostic test accuracy |
| url | http://www.sciencedirect.com/science/article/pii/S2589537022005375 |
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