The value of observing paroxysmal events: Comparing the diagnostic accuracy and confidence for clinical history compared to observation. (P1.243)

Objective: This study was designed to analyze the importance of history and semiology in differentiating different types of paroxysmal events, and how this impacts diagnostic accuracy for physicians with varying levels of expertise. Background: Paroxysmal events typically do not occur during routine EEGs. Only a limited number of tertiary care institutions can provide prolonged video-EEG monitoring, which is the gold standard for spell classification. Most patients with paroxysmal events are diagnosed based on histories provided to their physicians. With advances in cellphone camera technology, physicians are increasingly observing videos of events taken by patients/family to assist with clinical decision-making. Design/Methods: Forty seven Neurologists from a single center were asked to review 12 clinical histories and videos of patients who underwent spell classification in the Epilepsy Monitoring Unit (EMU). They were asked to classify each event as seizure, non-epileptic behavioral spell (NEBS), or other physiologic event; they were also asked to provide a confidence score (1–5, 5 being the highest) regarding their diagnosis. Results: Diagnostic accuracy for all paroxysmal events was 67% for history and 75% for observation (p=.001). This is largely due to improved accuracy within the NEBS patients (67% history vs. 83% video, p= Conclusions: Observation of the event in question may be a more valuable element in the evaluation of paroxysmal events than the description given by the patient. Physicians at different levels of expertise should encourage patients and their families to record and share videos to aide in medical decision-making. Disclosure: Dr. Hanrahan has nothing to disclose. Dr. Bagic has nothing to disclose. Dr. Hendrickson has nothing to disclose. Dr. Plummer has nothing to disclose. Dr. Ghearing has nothing to disclose. Dr. Popescu has nothing to disclose. Dr. Pan has nothing to disclose. Dr. Antony has nothing to disclose.