Accuracy of seizure semiology obtained from first-time seizure witnesses

Abstract

BackgroundLittle is known of how accurately a first-time seizure witness can provide reliable details of a semiology. Our goal was to determine how accurately first-time seizure witnesses could identify key elements of an epileptic event that would aid the clinician in diagnosing a seizure.MethodsA total of 172 participants over 17 years of age, with a mean (sd) of 33.12 (13.2) years and 49.4% female, composed of two groups of community dwelling volunteers, were shown two different seizure videos; one with a focal seizure that generalized (GSV), and the other with a partial seizure that did not generalize (PSV). Participants were first asked about what they thought was the event that had occurred. They then went through a history-taking scenario by an assessor using a battery of pre-determined questions about involvement of major regions: the head, eyes, mouth, upper limbs, lower limbs, or change in consciousness. Further details were then sought about direction of movement in the eyes, upper and lower limbs, the side of limb movements and the type of movements in the upper and lower limbs. Analysis was with descriptive statistics and logistic regression.ResultsOne hundred twenty-two (71.4%) identified the events as seizure or epilepsy. The accuracy of identifying major areas of involvement ranged from 60 to 89.5%. Horizontal head movements were significantly more recognized in the PSV, while involvement of the eyes, lateralization of arm movement, type of left arm movement, leg involvement, and lateralization of leg movement were significantly more recognized in the GSV. Those shown the GSV were more likely to recognize the event as "seizure" or "epilepsy" than those shown the PSV; 78 (84.8%) vs 44 (55.7%), (OR 0.22, p < 0.0001). Younger age was also associated with correct recognition (OR 0.96, P 0.049). False positive responses ranged from 2.5 to 32.5%.ConclusionFirst-time witnesses can identify important elements more than by chance alone, and are more likely to associate generalized semiologies with seizures or epilepsy than partial semiologies. However, clinicians still need to navigate the witness’s account carefully for additional information since routine questioning could result in a misleading false positive answer.

The utility of mobile telephone-recorded videos as adjuncts to the diagnosis of seizures and paroxysmal events in children with suspected epileptic seizures

“…[32] Witnesses tend to inaccurately describe movements, misleading medical professionals away from focal events. [33] Subtle features such as automatisms, lip movements or staring episodes are more difficult to identify, not just for lay persons but also healthcare professionals. [34] Different semiologies can be associated with different levels of reporting accuracy, with non-convulsive semiologies being less accurately described than convulsive events.…”

The Level of Public’s Practical Skills in Provision of First Aid to Patients with Major Epileptic Seizure

“…According to Botíková and Počuchová [9] findings, the awareness of the general public about EPI is high (80%). Another example is the research conducted by Muayqil et al [23], who found out that 71% of the overall number of 172 respondents from general public correctly identified epilepsy as the cause of the seizure. This also support Donáth and Čiernik [24] by their research, where 81% of patients treated for EPI think that the people around them are capable of providing them first aid during the epileptic seizure.…”

"Initial Approach to the First Epileptic Seizure in the Emergency Department"

“…It is at this point where the eyewitnesses of the event play a fundamental role, since they are a valuable source of information that should be questioned in a cautious manner in order to describe the events that occurred. A study in 2018 managed to prove that regardless of age or educational level, people who witness a seizure event have a high level of accuracy in describing it [9]. A first seizure event should initially be classified as provoked or unprovoked; provoked seizures may be due to acute or remote symptomatic factors, including metabolic disorders, acute infections, drug toxicity or structural brain lesions.…”