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Original Investigation
January 21, 2020

Assessment of the Predictive Value of Outpatient Smartphone Videos for Diagnosis of Epileptic Seizures

Author Affiliations
  • 1Department of Neurology, Mayo Clinic, Jacksonville, Florida
  • 2Department of Neurology, Yale University, New Haven, Connecticut
  • 3Department of Neurology, University of Pennsylvania, Philadelphia
  • 4Department of Neurology, Brown University, Providence, Rhode Island
  • 5Department of Neurology, Baylor College of Medicine, Houston, Texas
  • 6University of California, San Francisco, San Francisco
  • 7Department of Neurology, Mayo Clinic, Phoenix, Arizona
  • 8Department of Neurology, University of South Florida, Tampa
  • 9Department of Neurology, Mayo Clinic, Rochester, Minnesota
JAMA Neurol. Published online January 21, 2020. doi:10.1001/jamaneurol.2019.4785
Key Points

Question  How accurately does smartphone video–based diagnosis by epileptologists and residents predict final video electroencephalogram diagnosis of paroxysmal neurological events?

Findings  This diagnostic study conducted at 8 tertiary care epilepsy centers found that video reviewed by experts predicted a final diagnosis with an accuracy of 89% for epileptic seizures and 86% for psychogenic nonepileptic attacks. The findings also confirmed the ability to perform a secure exchange of smartphone videos among multiple institutions.

Meaning  This study provides class II evidence demonstrating the high accuracy of smartphone videography and validates its value as an adjunct to routine history and physical examination.

Abstract

Importance  Misdiagnosis of epilepsy is common. Video electroencephalogram provides a definitive diagnosis but is impractical for many patients referred for evaluation of epilepsy.

Objective  To evaluate the accuracy of outpatient smartphone videos in epilepsy.

Design, Setting, and Participants  This prospective, masked, diagnostic accuracy study (the OSmartViE study) took place between August 31, 2015, and August 31, 2018, at 8 academic epilepsy centers in the United States and included a convenience sample of 44 nonconsecutive outpatients who volunteered a smartphone video during evaluation and subsequently underwent video electroencephalogram monitoring. Three epileptologists uploaded videos for physicians from the 8 epilepsy centers to review.

Main Outcomes and Measures  Measures of performance (accuracy, sensitivity, specificity, positive predictive value, and negative predictive value) for smartphone video–based diagnosis by experts and trainees (the index test) were compared with those for history and physical examination and video electroencephalogram monitoring (the reference standard).

Results  Forty-four eligible epilepsy clinic outpatients (31 women [70.5%]; mean [range] age, 45.1 [20-82] years) submitted smartphone videos (530 total physician reviews). Final video electroencephalogram diagnoses included 11 epileptic seizures, 30 psychogenic nonepileptic attacks, and 3 physiologic nonepileptic events. Expert interpretation of a smartphone video was accurate in predicting a video electroencephalogram monitoring diagnosis of epileptic seizures 89.1% (95% CI, 84.2%-92.9%) of the time, with a specificity of 93.3% (95% CI, 88.3%-96.6%). Resident responses were less accurate for all metrics involving epileptic seizures and psychogenic nonepileptic attacks, despite greater confidence. Motor signs during events increased accuracy. One-fourth of the smartphone videos were correctly diagnosed by 100% of the reviewing physicians, composed solely of psychogenic attacks. When histories and physical examination results were combined with smartphone videos, correct diagnoses rose from 78.6% to 95.2%. The odds of receiving a correct diagnosis were 5.45 times greater using smartphone video alongside patient history and physical examination results than with history and physical examination alone (95% CI, 1.01-54.3; P = .02).

Conclusions and Relevance  Outpatient smartphone video review by experts has predictive and additive value for diagnosing epileptic seizures. Smartphone videos may reliably aid psychogenic nonepileptic attacks diagnosis for some people.

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