Analyzing reliability of seizure diagnosis based on semiology

Jin, Bo; Wu, Han; Xu, Jing; Yan, Jianwei; Ding, Yao; Wang, Z. Irene; Guo, Yi; Wang, Zhongjin; Shen, Chun‐Hong; Chen, Zhong; Ding, Meiping; Wang, Shuang

doi:10.1016/j.yebeh.2014.09.057

Cited by 16 publications

(16 citation statements)

References 17 publications

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“…Nonetheless, the majority of SVs were of adequate quality for clinical interpretation when reviewed by experts and residents. Clinicians with more experience evaluating patients with seizures demonstrated greater diagnostic accuracy [23] and a more appropriate level of confidence, in line with other reports [22,24,28,30]. Lastly, our study population was composed of patients with uncontrolled events.…”

Section: Discussionsupporting

confidence: 65%

Video quality using outpatient smartphone videos in epilepsy: Results from the OSmartViE study

Tatum

Hirsch

Gelfand

et al. 2021

Euro J of Neurology

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Background and purpose The aim of this study was to evaluate the quality of smartphone videos (SVs) of neurologic events in adult epilepsy outpatients. The use of home video recording in patients with neurological disease states is increasing. Experts interpretation of outpatient smartphone videos of seizures and neurological events has demonstrated similar diagnostic accuracy to inpatient video‐electroencephalography (EEG) monitoring. Methods A prospective, multicenter cohort study was conducted to evaluate SV quality in patients with paroxysmal neurologic events from August 15, 2015 through August 31, 2018. Epileptic seizures (ESs), psychogenic nonepileptic attacks (PNEAs), and physiologic nonepileptic events (PhysNEEs) were confirmed by video‐EEG monitoring. Experts and senior neurology residents blindly viewed cloud‐based SVs without clinical information. Quality ratings with regard to technical and operator‐driven metrics were provided in responses to a survey. Results Forty‐four patients (31 women, age 45.1 years [r = 20–82]) were included and 530 SVs were viewed by a mean of seven experts and six residents; one video per patient was reviewed for a mean of 133.8 s (r = 9–543). In all, 30 patients had PNEAs, 11 had ESs, and three had PhysNEEs. Quality was suitable in 70.8% of SVs (375/530 total views), with 36/44 (81.8%) patient SVs rated as adequate by the majority of reviewers. Accuracy improved with the presence of convulsive features from 72.4% to 98.2% in ESs and from 71.1% to 95.7% in PNEAs. An accurate diagnosis was given by all reviewers (100%) in 11/44 SVs (all PNEAs). Audio was rated as good by 86.2% of reviewers for these SVs compared with 75.4% for the remaining SVs (p = 0.01). Lighting was better in SVs associated with high accuracy (p = 0.06), but clarity was not (p = 0.59). Poor video quality yielded unknown diagnoses in 24.2% of the SVs reviewed. Features hindering diagnosis were limited interactivity, restricted field of view and short video duration. Conclusions Smartphone video quality is adequate for clinical interpretation in the majority of patients with paroxysmal neurologic events. Quality can be optimized by encouraging interactivity with the patient, adequate duration of the SV, and enlarged field of view during videography. Quality limitations were primarily operational though accuracy remained for SV review of ESs and PNEAs.

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Section: Discussionsupporting

confidence: 65%

Video quality using outpatient smartphone videos in epilepsy: Results from the OSmartViE study

Tatum

Hirsch

Gelfand

et al. 2021

Euro J of Neurology

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“…But, the sample population used was highly selective as only patients with refractory temporal lobe seizures were recruited, thereby limiting generalization of the result. Hirfanoglu et al [ 46 ], Rugg-Gunn et al [ 23 ], and Jin et al [ 47 ] reported contradictory findings, but obvious methodological variations can explain the disparity. Hirfanoglu carried out their study only on children, while Rugg-Gunn et al designed their study in a controlled laboratory environment.…”

Section: Discussionmentioning

confidence: 99%

“…This has led to researchers exploring various methods with a view to improving epilepsy accuracy. The use of questionnaires [ 21 , 30 ], video devices [ 39 , 46 , 50 ], repeated viewing of an event [ 47 ], and specialty diagnosis [ 47 ] are various options explored. It should also be said that the inability to correlate the seizure history with intracerebral activity in this study adds a limitation to the conclusion that can be made.…”

Section: Discussionmentioning

confidence: 99%

Calibration of the Epilepsy Questionnaire for Use in a Low-Resource Setting

Yaria

Ogunniyi

2020

Journal of Environmental and Public Health

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Background. Burden of epilepsy in sub-Saharan Africa is huge in the midst of shortage of human resource in its health sector. Using skilled staff to supervise and support lower level healthcare workers providing frontline primary healthcare is a pragmatic coping solution. But, lower level health providers face enormous challenges due to absent clinical algorithms or pragmatic rapid diagnostic tests. Objective. This study aimed to determine if the use of an epilepsy questionnaire in a traditional clinical setting would improve semiological details obtained and diagnostic accuracy. Methods. A prospective study was conducted involving patients diagnosed with epilepsy each with an eye witness who had regularly witnessed the seizures. Routine seizure history from clinical documentation and an interviewer-based questionnaire were compared. The data obtained were assessed for content, accuracy, intermethod and test-retest reliability. Results. Sixty-seven patients with a median age of 24 years were recruited. Routine seizure history had obtained less semiological details with inadequate description of nonmotor manifestations and lateralizing motor details. The questionnaire-obtained history showed higher accuracy for generalized onset seizure (0.83 vs. 0.56) and focal onset seizures (0.79 vs. 0.59). The questionnaire-obtained history also had good test-retest reliability for various semiological domains except automatisms. Conclusions. Routine seizure histories are not standardized. The use of a questionnaire goes a long way in improving semiology description in a low-resource setting and guides the health provider on what details to focus on. The use of epilepsy questionnaires should, therefore, be considered to improve semiology, especially in nonspecialist settings.

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“…69,70 Fortunately, studies also suggest that accuracy of diagnosing PNES (including by first responders and emergency providers) can be improved through targeted educational programs, by viewing more seizures on video, or otherwise by directed training in detection of relevant functional semiological features. 68,69 Finally, it is worth noting that patients with epilepsy may also have psychogenic seizures, and that patients with a history of PNES can also have ES. The co-occurrence of PNES and ES is approximately 10%, 71 although estimates vary widely.…”

Section: Psychogenic (Dissociative) Nonepileptic Seizuresmentioning

confidence: 99%

Functional (Psychogenic) Neurological Disorders: Assessment and Acute Management in the Emergency Department

et al. 2019

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Functional neurological disorders (FND, a.k.a. conversion disorder) are increasingly recognized as highly prevalent neurobehavioral-neuropsychiatric conditions. While patients with FND are frequently seen in outpatient neurology and primary care clinics, 1,2 these conditions are also common in emergency department (ED) settings. 3 While large-scale epidemiologic studies of incidence and prevalence are lacking, 4 there is robust evidence of high utilization of primary care, subspecialty, ED, and acute hospital services by patients with FND, resulting in considerable healthcare and societal costs. 5 Notably, patients with FND show elevated repeat ED visit rates in comparison to other conditions. 3 A variety of FND symptoms may lead to ED presentations, particularly those with paroxysmal or acute onset such as psychogenic nonepileptic seizures (PNES, a.k.a. dissociative seizures) or sensorimotor changes that mimic stroke. 6,7 Other FND symptoms that may lead to ED visits include functional movement disorders (FMDs), including functional tremor, gait disturbance, and/or dystonia. Appropriate triage of FND-related cases in the ED is not yet standardized and is often complex, requiring a time-sensitive, concurrent evaluation of neurological emergencies, as well as elements of shared neurology and neuropsychiatry expertise to provide an appropriate disposition and discharge plan.The assessment of FND has traditionally been a lengthy process utilizing tests that are not routinely performed in EDs Keywords ► conversion disorder ► psychogenic nonepileptic seizures ► functional movement disorders ► functional paralysis Abstract Functional neurological disorders (FND) are complex and prevalent neuropsychiatric conditions. Importantly, some patients with FND develop acute onset symptoms requiring emergency department (ED) evaluations. Historically, FND was a "rule-out" diagnosis, making assessment and management in the ED difficult. While the rapid triage of potential neurological emergencies remains the initial task, advancements have altered the approach to FND. FND is now a "rule-in" diagnosis based on validated neurological examination signs and semiological features. In this perspective article, we review signs and semiological features that can help guide the initial assessment of FND in the acute setting. Thereafter, we outline potential approaches to introduce a suspected diagnosis of FND to patients in the ED, while emphasizing the need for a comprehensive neurological evaluation. Physical and occupational therapy may be useful adjunct assessments in some individuals. Notably, clinicians in the ED setting are important members of the interdisciplinary approach to FND.While the clinical history is nonspecific for a diagnosis of FND, certain clues may help raise one's index of suspicion. 15 With regard to FND overall (including functional weakness,

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Analyzing reliability of seizure diagnosis based on semiology

Cited by 16 publications

References 17 publications

Video quality using outpatient smartphone videos in epilepsy: Results from the OSmartViE study

Video quality using outpatient smartphone videos in epilepsy: Results from the OSmartViE study

Calibration of the Epilepsy Questionnaire for Use in a Low-Resource Setting

Functional (Psychogenic) Neurological Disorders: Assessment and Acute Management in the Emergency Department

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