Families need tips on shooting seizure videos

Families and patients often bring in smartphone videos of seizures, which can help with epilepsy diagnosis, but people have to know how to shoot them correctly, according to investigators at the annual meeting of the American Epilepsy Society. The most common mistake that families make is not attempting to interact with the patient. Other common mistakes include not turning on the audio and failing to capture the entire body in the frame, they found.

Overall, “quality is adequate for clinical interpretation in the majority of patients that come to you with a smartphone video,” but when it’s not, it’s frequently because of “operator error, which is good because we can intervene and make some recommendations” to families and caregivers, said William Tatum, DO, a neurologist at Mayo Clinic Hospital in Jacksonville, Fla.

Dr. Tatum led a study in which epileptologists and neurology residents predicted diagnoses based on 50 smartphone videos of 44 patients. His team compared the results with the actual diagnoses from inpatient video-EEG monitoring.

On average, the videos were about 2 minutes in duration and helpful; over 80% of the time, suspected epileptic seizures and psychogenic nonepileptic attacks (PNEAs) captured in the smartphone videos turned out to be the correct diagnoses. The positive predictive value was 70.7% for epileptic seizures and 84.1% for PNEAs.

However, 120 video views, out of a total of 530 (23%), were not diagnostic. Sometimes the diagnosis was too tricky to discern from a video clip, but other times videos were simply not good enough. Besides not engaging with patients, turning on the audio, and filming the person’s entire body, videos were sometimes too short to capture the entire event and postictal period, or the lighting was too dim.

It’s common for people to come in with videos of convulsions, especially in pediatrics. “That happens a lot, and it can be really helpful,” to rule out true epileptic seizures, said Kevin M. Rathke, MD, a pediatric epileptologist at Duke University, Durham, N.C.

 Clues include flailing limbs, being able to talk and respond during an event, and responding when asked to do something such as holding up two fingers. “Closed eyes is a big one,” said Dr. Rathke, who helped moderate Dr. Tatum’s presentation.

The average age in the study was 45 years, and more than two-thirds of the subjects were women; 30 patients had a final diagnosis of PNEA, 11 had epileptic seizures, and 3 physiologic nonepileptic events.

Overall, residents were more confident than epileptologists were in using a smartphone video diagnosis, even when they were wrong.

There was no industry funding. Dr. Tatum had no relevant disclosures.