The role of seizure video recordings in the diagnosis of referred drug-resistant epilepsy: A stepwise approach

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research Pub Date : 2025-03-01 DOI:10.1016/j.eplepsyres.2025.107530

Duy Duan Nguyen , Thi Kim Anh Tran , Thi Phuoc Yen Tran , Quoc Nguyen Bao Pham , Toan Dinh Nguyen

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引用次数: 0

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.

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来源期刊

Epilepsy Research 医学-临床神经学

CiteScore

0.10

自引率

4.50%

发文量

143

审稿时长

62 days

期刊介绍： Epilepsy Research provides for publication of high quality articles in both basic and clinical epilepsy research, with a special emphasis on translational research that ultimately relates to epilepsy as a human condition. The journal is intended to provide a forum for reporting the best and most rigorous epilepsy research from all disciplines ranging from biophysics and molecular biology to epidemiological and psychosocial research. As such the journal will publish original papers relevant to epilepsy from any scientific discipline and also studies of a multidisciplinary nature. Clinical and experimental research papers adopting fresh conceptual approaches to the study of epilepsy and its treatment are encouraged. The overriding criteria for publication are novelty, significant clinical or experimental relevance, and interest to a multidisciplinary audience in the broad arena of epilepsy. Review articles focused on any topic of epilepsy research will also be considered, but only if they present an exceptionally clear synthesis of current knowledge and future directions of a research area, based on a critical assessment of the available data or on hypotheses that are likely to stimulate more critical thinking and further advances in an area of epilepsy research.