Digital health in the context of epilepsy diagnosis

Epilepsy is associated with a significant global burden of disease1, with recurrent unprovoked seizures having cognitive, biologic, psychological and social consequences2. To date the diagnosis and classification of seizures has relied largely on verbal description of paroxysmal events by patients or their caregivers.3 While this traditional approach is accurate in up to 90% of patients with epileptic seizures (ES), it is significantly less accurate in those with psychogenic nonepileptic attacks (PNEAs).1 As such, differential diagnosis for seizures is broad, and can have serious consequences.4 Video electroencephalogram (EEG) monitoring is recommended in cases of diagnostic uncertainty; however, it may not be suitable for all patients for multiple reasons including lack of access to video-EEG facilities and low frequency of events.1

With video-enabled smartphones commonplace in most homes, the medical community has started to explore their use as diagnostic/clinical decision-making tools.1,3 Recent studies have suggested that seizure data collected accurately using smartphones can aid clinical decision-making during the management of epilepsy.5,6 To better understand the application of smartphone video technologies in the management of epilepsy, we interviewed Professor Selim Benbadis from the Department of Neurology at the University of South Florida, Tampa, USA. Professor Benbadis is director of the University of South Florida /Tampa General Hospital Comprehensive Epilepsy Program, the busiest surgical epilepsy center in Florida. His interests are in the diagnosis and management of seizures that are difficult to control and the misdiagnosis of epilepsy. Even before the current pandemic he was pioneering the use of telemedicine and the self-monitoring of seizures to improve diagnosis and outcomes. Most recently he has been involved in the OSmartViE study, a prospective study looking at the accuracy of smart/cell phone video for diagnosing epileptic seizures.