Abstracts

Rationale: The diagnosis of epilepsy is primarily based on the history and the verbal description of the events in question. In addition, patients with infrequent episodes are poor candidates for EEG-video monitoring since the events are not likely to be captured. Cell phone footage is increasingly used to help with the final diagnosis. The purpose of this study is to evaluate the diagnostic value and yield of cell phone videos provided by families and caregivers. Methods: We prospectively reviewed cases of patients who presented to Tampa General Hospital Epilepsy Monitoring Unit (EMU) for evaluation of seizure-like events between November 2018 and June 2019. Three board-certified epileptologists interpreted the cell phone video with confidence scale from definite epileptic, probable epileptic, inconclusive/neutral, probable non-epileptic, and definite non-epileptic events. The video-based diagnosis was then compared to the eventual diagnosis based on inpatient EEG-video monitoring with recorded episodes. Cell phone and EMU diagnoses were made by two different epileptologists who were blinded to the other’s interpretation. Results: Eighteen patients were included in the final analysis [12/18 (67%) females, mean age 32.4 years old with standard deviation of 12.7 years, and mean age of onset of 16.6 years old]. Eight patients were not included: six patients due to an inconclusive EMU evaluation (normal EEG with no typical events captured), and two patients because the cell phone video was inconclusive (uninterpretable with poor quality). Ten patients had a conclusive cell phone video and a conclusive EMU evaluation, and the diagnosis was in agreement in all ten patients (four epileptic; six non-epileptic). Of the four epilepsy patients, three were successfully identified with the seizure type (two focal to bilateral tonic clonic seizures, one patient with myoclonic seizure). Of the six non-epileptic, five were correctly identified as psychogenic. There were no patients where the cell phone and the EMU diagnosis were discordant. Conclusions: When both cell phone video and EMU results were conclusive, there was 100% agreement in terms of epileptic vs. non-epileptic events. Cell phone video interpretation is a useful adjunctive tool in the diagnosis of seizure-like events, at least when reviewed by experienced epileptologists. Patients with seizure-like events should be encouraged to provide cell phone videos. Funding: No funding