Epileptic seizure or not? Proportion of correct judgement among medical doctors, medical students and parents based only on a video recording of a paroxysmal event

Abstract

Objective: Early recognition of epileptic seizures among neonates and infants is essential for proper treatment. Although, distinguishing between epileptic and non-epileptic seizures or harmless movements in this age seems to be challenging without any additional data. Our study intended to measure the proportion of correct seizure recognition among different medical and non-medical groups based on only a video recording. Methods: Video-EEG recordings were taken about paroxysmal movements of 15 very young infants (2 days – 5 months) at the EEG lab of our University Hospital. Only the video recordings (without EEG) were displayed for six groups: (1) 159 1st-year medical students, (2) 65 4-5th-year medical students, (3) 52 paediatric residents, (4) 18 paediatric neurologists from different European countries, (5) 43 adult neurologists and (6) 37 parents whose children were treated at our department with epilepsy. All participants were asked to decide which recording they considered of epileptic origin or a non-epileptic event. Correct answer rate (CAR) was calculated in every group for every video. Results: The average CAR was the lowest in the group of 1st-year medical students (36.6%), the best results were reached by paediatric neurologists (67.4%). The CAR was significantly different between the groups of 1st-year medical students and paediatric neurologists (p=0.02), and between the groups of 1st-year medical students and residents (p=0.045). The CAR of the most deceptive epileptic seizure was only 18.2%. The judgement of parents with epileptic children proved to be better than that of the 1st-year medical students. Conclusion: Recognising epileptic seizures in very young infants without EEG is extremely inaccurate. Trained paediatric neurologists were able to judge correctly the different movement types in only 67.4% of the cases. The role of education and experience is clearly indicated by the increase in CAR from 1st-year medical students through to well –trained paediatric neurologists.