Luiken, Rogier (2023) Distinguishing between hyperkinetic movement disorders: easy for the expert? thesis, Medicine.
Full text available on request.Abstract
Background: Currently, the diagnosis of the hyperkinetic movement disorders dystonia, tremor, myoclonus, chorea and tics is primarily established by the phenomenology of the clinical syndrome and therefore mainly based on expert opinion. However, previous research has shown that correct classification is challenging in many patients. This forms a major problem, as accurate recognition of the movement disorder phenotype is essential in guiding the patient’s further diagnostic process and treatment. Objective: The main aim of this study was to analyze inter-agreement and diagnostic decision-making on the classification of hyperkinetic movement disorders. Methods: Eighteen international movement disorder experts assessed a total of 57 patients with involuntary movement disorders. Each patient was assessed by three of the experts, which received information in a stepwise manner: (1) patient videos with movement tasks; (2) medical history and neurological examination; (3) results from additional diagnostic tests. At each step, the experts were asked to provide their most likely phenotype classification and to score their certainty of classification. Results: We found a ‘substantial’ inter-rater agreement on the classification of the primary movement disorder phenotype based on video alone (κ=0.61) and based on all available information (κ=0.74), with absolute agreement among three experts in 72% of the patients at the final classification step. Inter-rater agreement and certainty of classification increased at each step of the classification process. Conclusions: These findings suggest that diagnostic consensus among international experts based on video and clinical information is substantial. To further increase agreement and certainty of classification, future studies should focus on developing new diagnostic tools and biomarkers to aid clinicians in distinguishing between hyperkinetic movement disorders.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | De Koning-Tijssen, Prof. dr. and Van der Stouwe, Dr. |
| Faculty: | Medical Sciences |
| Date Deposited: | 01 May 2023 13:15 |
| Last Modified: | 01 May 2023 13:15 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3495 |
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