1. Expert review of smartphone videos possesses additive, predictive value for the diagnosis of epileptic seizures, with the ability to maintain confidentiality in the sharing of these files.
Evidence Rating Level: 2 (Good)
Video electroencephalogram (EEG) monitoring (VEM) is the ideal diagnostic standard for epileptic seizures when diagnosis is unclear through medical history, laboratory assessments, and witnessed seizures. However, misdiagnosis is common, 20% to 30% of patients who undergo VEM have nonepileptic seizures, and many patients face barriers to this procedure. This diagnostic study conducted across eight tertiary care epilepsy centers sought to evaluate reviewer accuracy in diagnosing epileptic seizures through smartphone videos, as well as identify psychogenic nonepileptic seizures. A total of 44 participants met inclusion criteria (mean [range] age = 45.1 [20-82] years, 70.5% female). Participants completed one diagnostic VEM session in an epilepsy monitoring unit prior to diagnosis by epilepsy and clinical neurophysiology experts. Final VEM-verified diagnoses included psychogenic nonepileptic seizures (30), epileptic seizures (11), and physiologic nonepileptic events (3). A total of 530 smartphone videos were reviewed by 19 reviewers (10 epilepsy experts, 9 senior neurology residents). While both of these groups demonstrated similar diagnostic specificity for epileptic seizures (88.3% and 93.3%, respectively), experts demonstrated greater sensitivity (76.8% and 41.5%). For psychogenic nonepileptic seizures, experts demonstrated greater specificity and sensitivity than neurology residents. In spite of a significant difference in duration of smartphone videos (mean = 2.23 minutes) compared to a standard 60-minute history and physical examination (p<0.001), interpretation of these smartphone videos was accurate in predicting epileptic seizures in 89.1% of cases (specificity = 93.3%). Increased odds of accurate diagnosis existed when smartphone videos were combined with history and physical examination compared to history and physical alone (95% CI 1.01 to 54.3, p<0.02). Findings suggest that patients with epileptic seizures are 6.65 times more likely to receive an accurate diagnosis with smartphone video and those with psychogenic nonepileptic seizures were 2.58 times more likely to receive an accurate diagnosis. Residents reported greater diagnostic confidence overall but were less accurate across all metrics of study. This study strongly suggests that smartphone videos of seizure may provide additive and predictive value to experts when diagnosing these complicated disorders and should be considered when patients are unlikely to engage in VEM.
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