Interobserver reliability of video recording in the diagnosis of nocturnal frontal lobe seizures.
BACKGROUND
Nocturnal frontal lobe seizures (NFLS) show one or all of the following semeiological patterns: (1) paroxysmal arousals (PA: brief and sudden recurrent motor paroxysmal behavior); (2) hyperkinetic seizures (HS: motor attacks with complex dyskinetic features); (3) asymmetric bilateral tonic seizures (ATS: motor attacks with dystonic features); (4) epileptic nocturnal wanderings (ENW: stereotyped, prolonged ambulatory behavior).


OBJECTIVE
To estimate the interobserver reliability (IR) of video-recording diagnosis in patients with suspected NFLS among sleep medicine experts, epileptologists, and trainees in sleep medicine.


METHODS
Sixty-six patients with suspected NFLS were included. All underwent nocturnal video-polysomnographic recording. Six doctors (three experts and three trainees) independently classified each case as "NFLS ascertained" (according to the above specified subtypes: PA, HS, ATS, ENW) or "NFLS excluded". IR was calculated by means of Kappa statistics, and interpreted according to the standard classification (0.0-0.20 = slight agreement; 0.21-0.40 = fair; 0.41-0.60 = moderate; 0.61-0.80 = substantial; 0.81-1.00 = almost perfect).


RESULTS
The observed raw agreement ranged from 63% to 79% between each pair of raters; the IR ranged from "moderate" (kappa = 0.50) to "substantial" (kappa = 0.72). A major source of variance was the disagreement in distinguishing between PA and nonepileptic arousals, without differences in the level of agreement between experts and trainees.


CONCLUSIONS
Among sleep experts and trainees, IR of diagnosis of NFLS, based on videotaped observation of sleep phenomena, is not satisfactory. Explicit video-polysomnographic criteria for the classification of paroxysmal sleep motor phenomena are needed.
Vignatelli
Luca
L
Department of Neurological Sciences, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna, Italy.
Bisulli
Francesca
F
Provini
Federica
F
Naldi
Ilaria
I
Pittau
Francesca
F
Zaniboni
Anna
A
Montagna
Pasquale
P
Tinuper
Paolo
P
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001332:Automatism / Q000145:classification / Q000175:diagnosis; D002648:Child; D015897:Comorbidity; D004569:Electroencephalography / Q000706:statistics & numerical data; D004576:Electromyography / Q000706:statistics & numerical data; D017034:Epilepsy, Frontal Lobe / Q000145:classification / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020183:Nocturnal Paroxysmal Dystonia / Q000145:classification / Q000175:diagnosis; D015588:Observer Variation; D020447:Parasomnias / Q000145:classification / Q000175:diagnosis*; D017286:Polysomnography / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D019956:Stereotypic Movement Disorder / Q000145:classification / Q000175:diagnosis; D014743:Videotape Recording / Q000592:standards / Q000706:statistics & numerical data*