The Effect of Smartphone Video on Lead Time to Diagnosis of Epileptic Spasms in Infants
Abstract number :
3.203
Submission category :
4. Clinical Epilepsy / 4B. Clinical Diagnosis
Year :
2021
Submission ID :
1825747
Source :
www.aesnet.org
Presentation date :
12/9/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:50 AM
Authors :
Chethan Rao, DO, MS - Mayo Clinic Florida; Douglas Nordli, MD – Resident Physician, Child and Adolescent Neurology, Mayo Clinic Florida; Raj Sheth, MD – Professor, Division Chief, Program Director, Child and Adolescent Neurology, Mayo Clinic Florida/Nemours Children's
Rationale: Early recognition and treatment of infantile epileptic spasms is associated with better seizure and developmental outcomes1. Epileptic spasms can be recognized by video spell capture in the appropriate clinical context2, however, the utility of smartphone video spell capture in the diagnosis of epileptic spasms has not yet been quantified. At least 95% of adults between ages 18-39 own smartphones in the United States with rates growing globally. We hypothesized that access to smartphone video capture of spells available at initial presentation significantly reduces lead times to diagnosis and treatment of epileptic spasms.
1. O'Callaghan FJ, Lux AL, Darke K, et al. The effect of lead time to treatment and of age of onset on developmental outcome at 4 years in infantile spasms: evidence from the United Kingdom Infantile Spasms Study. Epilepsia 2011;52:1359-1364.
2. Wilmshurst JM, Gaillard WD, Vinayan KP, et al. Summary of recommendations for the management of infantile seizures: Task Force Report for the ILAE Commission of Pediatrics. Epilepsia 2015;56:1185-1197.
Methods: We conducted a retrospective case-control study of infants with new onset epileptic spasms between September 2010 and March 2021 at our tertiary pediatric center in Jacksonville, Florida. We compared cases (known diagnosis of epileptic spasms presenting with smartphone video of spells) and age- and sex-matched controls (known diagnosis of epileptic spasms presenting without smartphone video of spells) and assessed the difference in lead time to initial EEG, to diagnosis, and to treatment as well as treatment outcome (responder status and developmental delay). Statistical significance was assessed by independent sample T-tests and chi-square.
Results: Twenty-eight consecutive patients (2 to 15 months of age; M/F=0.65) were included: 16 Smartphone Video and 12 No Smartphone Video. Age, sex, etiology, EEG duration, and initial treatment type were similar between both groups (Table). Lead time was shorter in the Smartphone Video group with a trend toward significance from first spasms to first EEG, diagnosis, and treatment initiation. Presence of hypsarrhythmia on initial EEG was similar between groups, but spasms were more likely to be captured on initial EEG in the group with smartphone video capture at presentation. Similarly, developmental delay at last follow up was similar between groups, but patients in the Smartphone Video group were less likely to be identified with Lennox-Gastaut syndrome at last follow up. Importantly, the Smartphone Video group had significantly higher initial treatment responder rates.
Conclusions: Our findings support the utility of smartphone video capture of infantile epileptic spasms for improved time to diagnosis and initial treatment as well as superior treatment response. This highlights the importance of clinician review of smartphone video as an adjunct to routine history. Further studies with larger cohorts are needed to confirm our findings and to examine the effect these methods have on seizure and developmental outcomes.
Funding: Please list any funding that was received in support of this abstract.: None.
Clinical Epilepsy