Can home videos made on smartphones complement video-EEG in diagnosing psychogenic nonepileptic seizures?

Abstract

Purpose: To assess the contribution home-videos made on mobile phones can make to the diagnosis of Psychogenic Nonepileptic Seizures (PNES).

Methods: Consecutive patients 10-50 years old, with episodes of altered behavior or abnormal movements, unresponsiveness, or falls, were recruited after they had obtained 'good' or 'fair' quality (quality of video scale (QOV)) home-videos of their episodes on personal mobile phones; these subjects underwent video-electroencephalography (VEEG). Diagnoses of PNES, other physiological events or epileptic seizure (ES) on home-videos (by the epilepsy fellow, step 1) and on VEEGs (by a fully trained epileptologist unaware of the home-video recording, step 2) were compared.

Results: We screened 783 patients, and finally analyzed 269; 155 subjects had `fair' (QOV 5-7) and 114 had 'good'(QOV 8-10) quality home-videos. Concordance between steps 1 and 2 was seen in 261 of 269 (97.2%) subjects, and no significant difference was noted between the two modalities in diagnosing PNES. Differentiation between PNES, ES and other physiological events using home-videos was correct in 49.1% subjects if 532 (all subjects asked to make home-videos) and 70.7% if 369 (subjects with 'good' or 'fair' home videos), were used as denominators. Home-videos diagnosed PNES with the sensitivity of 95.4% (95% CI: 87.2%-99.1%), specificity of 97.5% (95% CI: 94.3%-99.2%), positive and negative predictive values of 92.65% (95% CI: 84.1%-96.8%) and 98.5% (95% CI: 95.6%-99.5%) respectively.

Conclusion: Home-videos of good quality can complement VEEG in diagnosing PNES in a cost-effective way and help initiate appropriate management.

Keywords: Epilepsy; Home videos; Mobile phones; PNES.