Authors :
Presenting Author: Marina Azevedo, BS – University of South Florida
Ana Miller, BSc – University of South Florida
Nicholas Tenney, MS4 – University of South Florida
Ushtar Amin, MD – University of South Florida
Angélica Rivera-Cruz, MD – University of South Florida
Kristen Zemina, MD – University of South Florida
Selim Benbadis, MD – University of South Florida
Rationale:
Inpatient EEG-video monitoring is the gold-standard for seizure diagnosis, and its main purpose is to record the events or seizures in question. Up to 23% of inpatient EEG-video monitoring admissions may fail to capture events [1]. Recent studies have shown the value of cellphone videos in diagnosing seizures [2]. Our objective was to assess the yield and diagnostic value of cellphones videos obtained after inconclusive inpatient EEG-video monitoring.Methods:
We prospectively collected patients whose Epilepsy Monitoring Unit (EMU) evaluation was inconclusive, between September 2023 and June 2025. Inconclusive studies were defined as failure to record the events in question, and were subdivided as follows:
1) Completely inconclusive, ie no interictal epileptiform discharges (IEDs) and no events.
2) Partially conclusive with no IEDs, some events recorded but not all types.
3) Partially conclusive with IEDs but no events.
4) Partially conclusive with IEDs, some events recorded but not all types.
All patients were asked to record and submit a video of any typical event that was not captured during their EMU stay. Each submitted video was independently reviewed by two epileptologists who were not involved in the patient’s care. If the initial two reviewers disagreed, a third epileptologist reviewed the video to serve as a tiebreaker and determine the final classification. Reviewers were asked to analyze the videos provided by the patients and make a final diagnosis with one of the following 5 options:
1) Epileptic
2) Non-epileptic psychogenic
3) Non-epileptic physiologic
4) Epileptic and psychogenic
5) Inconclusive
Results:
Over a 20-month period, there were 500 EMU admissions, of which 131 (26%) were inconclusive (Figure 1).
Of those, cellphone videos were obtained in 20 out of 131 patients (15%). See table 1.
Eighteen of the 20 (90%) had repeated inconclusive EEGs before we obtained a cellphone video. The median length between EMU discharge and obtaining a cellphone video was 1 month. A third reviewer was needed for 7/20 (35%) of the videos received.
Final review of the cellphone videos:
- 3/20 (15%) the cellphone video were inconclusive.
- 17/20 (85%) videos were conclusive and allowed for a confident diagnosis.
. 5/20 (25%) showed a non-epileptic psychogenic event.
. 10/20 (50%) showed a epileptic seizure.
. 2/20 (10%) showed a physiologic event.
Conclusions:
1. It is challenging to obtain cellphone videos after discharge from an inconclusive EMU evaluation. Only 15% of patients provided them. We encountered some skepticism towards cellphone videos, with the misconception that only traditional tools such as EEGs and MRIs can provide a diagnosis.
2. When obtained, cellphone videos provided a diagnosis in 85% of patients.
3. Providers should aim to better educate patients and families on the value stand-alone videos for the diagnosis of seizures.
References
1. Benbadis SR et al. Outcome of prolonged EEG-video monitoring at a typical referral epilepsy center. Epilepsia 2004;45:1150-1153.
2. Amin U et al. The value of smartphone videos for the diagnosis of seizures. Epilepsia 2021 Jul 13. doi: 10.1111/epi.17001.
Funding: None.