1. The role of seizure video recordings in the diagnosis of referred drug-resistant epilepsy: A stepwise approach.
- Author
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Nguyen DD, Tran TKA, Tran TPY, Pham QNB, and Nguyen TD
- Abstract
Background: Patient-recorded videos offer a practical alternative for diagnosing epilepsy and psychogenic nonepileptic seizures (PNES), yet their diagnostic value across sequential clinical questions remains underexplored., Objective: To assess the diagnostic utility of patient-recorded seizure videos in distinguishing epilepsy from PNES, classifying seizure types, and localizing and lateralizing epileptic foci, as well as their impact on physician confidence and interrater reliability., Methods: In this prospective two-phase study, 40 patients referred for drug-resistant epilepsy evaluation were screened, 30 of whom met the inclusion criteria. Diagnoses were made by one neurologist and confirmed by an independent neurologist via clinical data, electroencephalography, neuroimaging, and patient-recorded videos. Three neurologists independently reviewed cases across four diagnostic steps: (1) epilepsy vs. PNES, (2) focal vs. generalized epilepsy, (3) seizure localization: temporal vs. extratemporal, and (4) seizure lateralization: right vs. left. Diagnostic accuracy, physician confidence, and interrater reliability were analyzed before and after video integration., Results: Diagnostic accuracy achieved excellent results before and after watching videos in Step 1 (91.67-95 %) and Step 2 (95.93-100 %). After the videos were reviewed, the accuracies in Steps 3 and 4 were good, reaching 83.87 % and 81.48 %, respectively. Videos significantly increased physician confidence across all steps. Interrater reliability improved for Steps 1 and 2-0.67 and 1.00, respectively. Those of seizure localization and lateralization slightly decreased, accompanied by increased accuracy, reflecting a trend toward inconsistent alterations to correct diagnoses among physicians., Conclusion: The accuracy of epilepsy diagnosis in steps 1 and 2 is excellent, and that in steps 3 and 4 is good. Their integration with v-EEG and other diagnostic modalities, such as neuroimaging and invasive techniques, can enhance diagnostic workflows by providing complementary semiological information. Further studies with larger cohorts are warranted to confirm these findings and optimize their application in clinical practice., (Copyright © 2025 Elsevier B.V. All rights reserved.)
- Published
- 2025
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