NR AHLR
AU Litvan,I.I.; Jankovic,J.; Goetz,C.G.; Wenning,G.K.; Sastry,N.; Jellinger,K.A.; McKee,A.; Lai,E.C.; Brandel,J.P.; Verny,M.; Ray-Chaudhuri,K.; Pearce,R.K.; Bartko,J.J.; Agid,Y.
TI Accuracy of the clinical diagnosis of postencephalitic parkinsonism: a clinicopathologic study.
QU European Journal of Neurology 1998 Sep; 5(5): 451-457
PT journal article
AB The accuracy of the clinical diagnosis of postencephalitic parkinsonism (PEP) is unknown. We determined the validity of the clinical diagnosis of PEP by presenting 105 records with neuropathologic diagnoses of PEP (n = 7), progressive supranuclear palsy (n = 24), Parkinson's disease (n = 15), dementia with Lewy bodies (n = 14), multiple system atrophy (n = 16), corticobasal degeneration (n = 10), Creutzfeldt-Jakob disease (n = 4), and other dementia disorders (n = 15), as clinical vignettes to six neurologists unaware of the autopsy findings. The neurologists' own clinical diagnoses were compared with neuropathologic diagnoses for measures of diagnostic accuracy, including reliability (kappa statistics), sensitivity and positive predictive values for the first and last visits. The group reliability for the diagnosis of PEP was almost perfect (kappa = 0.91, 0.9). The mean sensitivity at the first visit was 86% (range, 71-100%) with minimal change at the last visit (83%; range, 71-100%). Positive predictive values remained unchanged (100%). The high reliability, sensitivity and positive predictive values of the clinical diagnosis of PEP indicate that neurologists identify this disorder even when they report that they have never evaluated a case. In our data set, the best predictors for the diagnosis of PEP included onset below middle age; symptom duration lasting more than 10 years, and the presence of oculogyric crisis. History of encephalitis lethargica, present in most PEP cases, was an important individual diagnostic predictor. Copyright 1998 Lippincott Williams & Wilkins
AD Irene Litvan and Narahary Sastry (Neuroepidemiology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892-9130, USA), Joseph Jankovic, Eugene C. Lai (Department of Neurology, Baylor College of Medicine, Houston, Texas, USA), Christopher G. Goetz (Department of Neurology, Rush Medical College, Chicago, Illinois, USA), Gregory K. Wenning (Institute of Neurology, London, UK), Kurt Jellinger (Ludwig Boltzmann Institute of Clinical Neurobiology, Vienna, Austria), Ann McKee (Department of Neuropathology, Massachusetts General Hospital, Boston, Massachusetts, USA), Jean-Philippe Brandel and Yves Agid (Fédération de Neurologie and INSERM U 289, Hôpital de la Salpêtrière, Paris, France), Marc Verny (Raymond Escourolle Neuropathology Laboratory, INSERM U 360, Hôpital de la Salpêtrière, Paris, France), Ray-Chaudhuri (Department of Neurology, Institute of Psychiatry, London, UK), Ron K.B. Pearce and John J. Bartko (Division of Epidemiology and Research Studies, National Institute of Mental Health, Bethesda, Maryland, USA)
SP englisch