Abstracts

Rationale: Mimics of epilepsy such as psychogenic nonepileptic seizures (PNES) are common.1 The accuracy of a historical diagnosis for epilepsy is good, but for PNES only moderate .2 We present the initial findings from a multi-center prospective trial of smartphone use in epilepsy and address video quality. Home videos have been used as a diagnostic adjunct in epilepsy. 3,4 To address the impact of video quality of smartphones in people with epilepsy (PWE), we sought to evaluate the routine H&P for diagnosis. Methods: Patient-generated smart-phone videos (SV) were acquired prior to video-EEG monitoring (VEM). Using the SV, epileptologists and senior neurology residents were forced to choose a diagnosis of 1) ES, 2) PNES, or 3) physiologic nonepileptic events (PhysNEE). Data sharing was performed via HIPPA-protected data transfer utilizing a web-based software submission (Captureproof®). Video quality was assessed using survey questions that addressed aspects such as lighting, audio and clarity of the SV. Results: The first 25 patients (16 F) with a mean age of 46 yrs (range 20-81) received VEM with SV review by 7 epileptologists and 7 residents. VEM demonstrated 8/25 (32%) with epilepsy, 14/25 (56%) with PNES and 3/25 (12%) with PhysNEE. For an epilepsy diagnosis, a 53% sensitivity, but a 92% specificity was seen. Overall, based upon the SV, PNES was identified with a sensitivity of 89% and specificity of 74% for a PPV of 77% PPV. SV clarity was adequate with 72% reporting that the overall video quality was suitable to make a prediction. 64% agreed that the duration of video was sufficient. Lighting was deemed too dark 21% of the time. Video clarity was largely adequate, yet 16% of videos were reported as blurry or out of focus. The most commonly reported drawback was limited whole body view.  Conclusions: Most SV were adequate in clarity, audio, and light according to physician review. SV were mostly limited by lack of whole body view and ictal period recorded. The specificity of an ES diagnosis, in addition to the sensitivity of a PNES diagnosis makes SV a useful adjunct to routine H & P in clinical practice. Funding: Mayo Clinic