Smartphones in the Clinic: How Patient Videos Can Change Seizure Diagnosis

William O. Tatum, DO

A study recently published in JAMA Neurology assessed the accuracy of outpatient smartphone videos for diagnosing epilepsy.¹

The study, conducted by William O. Tatum, DO, director of the Comprehensive Epilepsy Center and professor of neurology at Mayo Clinic College of Medicine & Health Sciences, and colleagues, encapsulates the overall movement towards incorporating technology into everyday clinical care.

The investigators found that outpatient smartphone videos are reliable and demonstrate a predictive value for diagnosing epileptic seizures. The study included 44 outpatients, each submitting a smartphone video for review prior to electroencephalogram (EEG) monitoring. A total of 530 video reviews were conducted, with expert epilepsy reviewers accurately predicting a video EEG diagnosis of epileptic seizures 89.1% of the time (95% CI, 84.2%-92.9%), with a specificity of 93.3% (95% CI, 88.3%-96.6%). The reviewers diagnosed epileptic seizures, psychogenic nonepileptic attacks, and physiologic nonepileptic attacks.

Notably, the odds of receiving a correct diagnosis were 5 times greater when medical history and physical exam were combined with smartphone videos (95% CI, 1.01-54.3; P =.02).

In an interview with NeurologyLive, Tatum detailed the results of the study that surprised him and commented on the future potential of incorporating smartphone technology into epilepsy care.

NeurologyLive: Were you surprised by any of the findings of the study?

William Tatum, DO: I expected that use of video would be useful for diagnosis of epilepsy, but was surprised at the degree of accuracy. We found an increase in the diagnostic yield, which rose to 95.2%, when history and physical examination were combined with a smartphone video. Additionally, I was surprised by the over-confidence held by resident physicians compared to experts, suggesting experience is important when using smartphone videos alone without EEG to predict a diagnosis.

In the future, can you see more epileptologists utilizing smartphone technology to help diagnose patients?

Epileptologists are already seeing smartphone videos brought to the clinic by patients. This is only likely to increase with increasing patient sophistication and the overall availability of smartphones as they become more engrained in our society. Smartphone use is very high in developed as well as under-developed countries and therefore what we're seeing in all parts of the United States may extend to other areas throughout the world.

Given the diagnostic accuracy in psychogenic attacks, would you encourage patients/caregivers to try to capture these instances on video in order to improve diagnosis and ultimately, management?

Absolutely, "a picture is worth a thousand words" and it is incumbent upon each physician to amass as much information as possible to make a correct diagnosis. Misdiagnosis has significant downfalls including use of antiseizure medication, loss of driving privileges, social isolation, and financial implications. Therefore, with a high degree of accuracy and inter-rater reliability in patients with nonepileptic conditions, encouraging patients to capture a video as adjunctive information to a complete and detailed history and physical examination is what we currently recommend. It is also important to point out that there are pitfalls in interpreting smartphone videos as there are in the historical recount of seizures and therefore it’s implicit that no test should be independently utilized.

REFERENCE

Tatum WO, Hirsch LJ, Gelfand MA, et al. Assessment of the predictive value of outpatient smartphone videos for diagnosis of epileptic seizures. JAMA Neurol. Published online January 21, 2020. doi:10.1001/jamaneurol.2019.4785.