Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
Department of Neurology, Yale University, New Haven, CT, USA.
Eur J Neurol. 2021 May;28(5):1453-1462. doi: 10.1111/ene.14744. Epub 2021 Feb 11.
The aim of this study was to evaluate the quality of smartphone videos (SVs) of neurologic events in adult epilepsy outpatients. The use of home video recording in patients with neurological disease states is increasing. Experts interpretation of outpatient smartphone videos of seizures and neurological events has demonstrated similar diagnostic accuracy to inpatient video-electroencephalography (EEG) monitoring.
A prospective, multicenter cohort study was conducted to evaluate SV quality in patients with paroxysmal neurologic events from August 15, 2015 through August 31, 2018. Epileptic seizures (ESs), psychogenic nonepileptic attacks (PNEAs), and physiologic nonepileptic events (PhysNEEs) were confirmed by video-EEG monitoring. Experts and senior neurology residents blindly viewed cloud-based SVs without clinical information. Quality ratings with regard to technical and operator-driven metrics were provided in responses to a survey.
Forty-four patients (31 women, age 45.1 years [r = 20-82]) were included and 530 SVs were viewed by a mean of seven experts and six residents; one video per patient was reviewed for a mean of 133.8 s (r = 9-543). In all, 30 patients had PNEAs, 11 had ESs, and three had PhysNEEs. Quality was suitable in 70.8% of SVs (375/530 total views), with 36/44 (81.8%) patient SVs rated as adequate by the majority of reviewers. Accuracy improved with the presence of convulsive features from 72.4% to 98.2% in ESs and from 71.1% to 95.7% in PNEAs. An accurate diagnosis was given by all reviewers (100%) in 11/44 SVs (all PNEAs). Audio was rated as good by 86.2% of reviewers for these SVs compared with 75.4% for the remaining SVs (p = 0.01). Lighting was better in SVs associated with high accuracy (p = 0.06), but clarity was not (p = 0.59). Poor video quality yielded unknown diagnoses in 24.2% of the SVs reviewed. Features hindering diagnosis were limited interactivity, restricted field of view and short video duration.
Smartphone video quality is adequate for clinical interpretation in the majority of patients with paroxysmal neurologic events. Quality can be optimized by encouraging interactivity with the patient, adequate duration of the SV, and enlarged field of view during videography. Quality limitations were primarily operational though accuracy remained for SV review of ESs and PNEAs.
本研究旨在评估成人癫痫门诊患者智能手机视频（SV）的质量。在家中对患有神经疾病的患者进行视频记录的使用正在增加。专家对癫痫发作和神经事件的门诊智能手机视频的解释已证明与住院视频-脑电图（EEG）监测具有相似的诊断准确性。
进行了一项前瞻性、多中心队列研究，以评估 2015 年 8 月 15 日至 2018 年 8 月 31 日期间阵发性神经事件门诊患者的 SV 质量。癫痫发作（ES）、心因性非癫痫发作（PNEA）和生理性非癫痫发作（PhysNEE）通过视频-EEG 监测得到证实。专家和高级神经科住院医师在没有临床信息的情况下盲目查看基于云的 SV。在对调查的回应中，提供了有关技术和操作员驱动指标的质量评分。
共纳入 44 例患者（31 例女性，年龄 45.1 岁[r=20-82]），共观察了 530 例 SV，平均由 7 位专家和 6 位住院医师观看；每位患者的视频平均观看 133.8 秒[r=9-543]。共有 30 例患者出现 PNEAs，11 例出现 ES，3 例出现 PhysNEE。70.8%（530 总视图中的 375 个）的 SV 质量合适，44 名患者中有 36 名（81.8%）的患者 SV 被大多数评审者评为合适。在 ES 中，具有惊厥特征的准确性从 72.4%提高到 98.2%，在 PNEAs 中从 71.1%提高到 95.7%。在 44 例 SV 中，所有评审员（100%）均给出了准确诊断（所有均为 PNEAs）。与其余 SV 相比（p=0.01），这些 SV 的音频被 86.2%的评审员评为良好，而其余 SV 的音频被 75.4%的评审员评为良好。与准确性高的 SV 相比，光照条件在准确性高的 SV 中更好（p=0.06），但清晰度没有（p=0.59）。在审查的 SV 中，24.2%的 SV 质量较差，导致诊断不明。妨碍诊断的特征是交互性有限、视野受限和 SV 持续时间短。
智能手机视频质量在大多数阵发性神经事件门诊患者的临床解释中是足够的。通过鼓励与患者互动、SV 持续时间充足以及录像时视野扩大，可以优化视频质量。质量限制主要是操作上的，但 ES 和 PNEAs 的 SV 审查仍保持准确性。
