Abstracts

Rationale:
The COVID 19 pandemic halted nonepileptic seizure diagnosis by forcing our epilepsy monitoring unit to close.  Prior series have demonstrated outpatient short-term induction video-EEG (iEEG)has a yield approximating inpatient monitoring has the potential to provoke a different semiology from the habitual event experienced at home (1).  To improve diagnostic accuracy, we attempted to match the semiology of outpatient ictal cell phone videos (2) with subsequent events provoked by iEEG.
Method:
Patients were seen clinically for outpatient epilepsy care.  Those with frequent seizures were instructed to submit videos of their events to be reviewed by an epileptologist.  If the cell phone data suggested a nonepileptic etiology, patients were offered an outpatient iEEG.
Results:
Two patients submitted video which were likely nonepileptic seizures and had subsequent iEEG.  One of them did not have a successful induction.  The other was successful and her case is described below.  Case: A woman with no epilepsy risk factors had new onset seizures occurring 4 times per week. During the initial telephone evaluation, she had an event of loss of awareness.  Ictal cell phone videos were submitted, and the epileptologist determined that the loss of awareness event was likely nonepileptic in part due to prolonged eye closure. During the subsequent iEEG she had a spell that was similar.  Since the ictal cell phone semiology matched the subsequent EEG negative semiology the algorithm succeeded in establishing the diagnosis of nonepileptic seizures.  After diagnosis she was followed for a month and has started therapy but without improvement.  
Conclusion:
Forced by COVID-19 to become creative about outpatient differential diagnosis, we found that ictal cell phone video semiology can be paired with subsequent suggestion induction vEEG to establish a nonepileptic seizure diagnosis.  Using this algorithm we managed to diagnose one patient with nonepileptic seizures, wean her off of antiseizure medication, and refer her to therapy. There are limitations of this algorithm.  Requiring ictal cell phone videos reduces the sensitivity of the combined test.  In addition, specificity may be compromised when more than one semiology is present or is not captured by cellphones or during induction. Video-EEG remains the gold-standard for differential diagnosis, but ictal cell phone video of habitual events followed by outpatient induction video EEG may be a useful alternative when admission to an epilepsy monitoring unit is impossible. Citations: •Benbadis SR, Siegrist K, Tatum WO, Heriaud L, Anthony K. Short-term outpatient EEG video with induction in the diagnosis of psychogenic seizures.  2004 Nov 9;63(9):1728-30 •Tatum WO, Hirsch LJ, Gelfand MA, Acton EK, LaFrance WC Jr, Duckrow RB, Chen DK, Blum AS, Hixson JD, Drazkowski JF, Benbadis SR, Cascino GD; OSmartViE Investigators. Assessment of the Predictive Value of Outpatient Smartphone Videos for Diagnosis of Epileptic Seizures. JAMA Neurol. 2020 May 1;77(5):593-600.
Funding:
:None