Video Quality Using Outpatient Smartphone Videos in Epilepsy: Results from the OsmartViE Study.

BACKGROUND: To evaluate the quality of smartphone videos (SVs) in adult epilepsy outpatients.

METHODS: A prospective, multicenter cohort study evaluated SV quality in patients with paroxysmal neurologic events from 8/15/2015 through 8/31/2018. Epileptic seizures (ES), psychogenic nonepileptic attacks (PNEA), and physiologic nonepileptic events were confirmed by video-EEG monitoring. Experts and senior neurology residents blindly viewed cloud-based SVs without clinical information. Quality rating was surveyed for technical and operator-driven metrics. P<.05 significant.

RESULTS: Forty-four patients [31 F, age 45.1 yrs. (r = 20-82)] and 530 SVs were viewed by a mean of 7 experts and 6 residents/one video per patient over 133.8 sec. (r = 9-543). 30 patients had PNEA, 11 ES, and 3 physiologic nonepileptic events. Quality was suitable in 70.8% (375/530 total views) with 36/44 (81.8%) patient SVs rated adequate by majority. Accuracy improved with convulsive features from 72.4% to 98.2% in ES and from 71.1% to 95.7% in PNEA. 11/44 videos had 100% accuracy (all PNEA). Audio was rated as good by 86.2% for these videos vs 75.4% of reviewers for the remainder (P=.01). Lighting was better in high accuracy videos (P=.06), but not clarity (P=.59). Poor video quality yielded unknown diagnoses in 24.2% of videos. Features hindering diagnosis were limited interactivity, restricted field of view and short video duration.

CONCLUSIONS: SV quality is adequate for clinical interpretation in majority of patients with paroxysmal neurologic events. Quality can be optimized by encouraging patient interactivity, adequate duration and enlarged field of view during videography.