Rationale:
Differentiating epileptic versus non-epileptic events in acute clinical setting is crucial as they require different treatment approaches. The gold standard for diagnosis is video EEG monitoring. There are clinical clues to assist clinicians in acute settings before video-EEG is performed. This study aims to improve the clinician’s diagnosis of non-epileptic events by using clinical clues.
Methods:
General pediatric residents at SUNY Downstate participated in this study. A pre-teaching survey was done, and answers were compared with post-teaching. A brief teaching session provided clinical clues defined by previous studies to help them diagnose non-epileptic events at bedside. These clues included side-to-side head movements, out of phase, non-rhythmic movements, eyes closed, and forward pelvic thrusting. Five patient videos were shown during teaching session to the residents in the following order: Case 1 non-epileptic event, Case 2 frontal lobe seizure, Case 3 non-epileptic event, Case 4 generalized tonic clonic seizure (GTCS), and Case 5 non-epileptic event. First two videos were shown during pre-teaching and again during post-teaching surveys. Residents were asked to choose the diagnosis of “seizure” versus “not seizure” for each video, followed by selecting clinical clues that they found helpful in making the diagnosis. Three months later, a follow-up session was held, and residents answered the same questions about the same five patient videos and answers were compared with previous data.
Results:
During the initial teaching session, 17 residents and at three months follow up 21 residents participated in the survey. Table 1 shows the correct response rates at baseline and at three months follow up. Correct response rate among participants was 70% (median, interquartile range: 60-80%) at three months follow up compared to 50% (median, interquartile range: 40%-60%) at baseline. “Out of phase, non-rhythmic movements” was the most commonly used clinical clue. During the initial teaching, 29% of participants (5 participants, N=17) felt confident in diagnosing non-epileptic events and at three months follow up 33% (7 participants, N=21) of participants were confident in diagnosing non-epileptic events. Conclusions:
Teaching clinical clues improved clinical diagnosis of non-epileptic events in pediatrics residents, and the knowledge was retained at three month follow up evaluation. The most challenging case was the patient with high frequency movements mimicking rhythmic clonic movements. The second most difficult case was the frontal lobe seizure that was often diagnosed as non-epileptic event by participants.
Funding: None