title: Inter-observer agreement of canine and feline paroxysmal event semiology and classification by veterinary neurology specialists and non-specialists.
abstract: BACKGROUND
  Advances in mobile technology mean vets are now commonly presented with videos of paroxysmal events by clients, but the consistency of the interpretation of these videos has not been investigated. The objective of this study was to investigate the level of agreement between vets (both neurology specialists and non-specialists) on the description and classification of videos depicting paroxysmal events, without knowing any results of diagnostic workup. An online questionnaire study was conducted, where participants watched 100 videos of dogs and cats exhibiting paroxysmal events and answered questions regarding: epileptic seizure presence (yes/no), seizure type, consciousness status, and the presence of motor, autonomic and neurobehavioural signs. Agreement statistics (percentage agreement and kappa) calculated for each variable, with prevalence indices calculated to aid their interpretation.
  
  
  RESULTS
  Only a fair level of agreement (κ = 0.40) was found for epileptic seizure presence. Overall agreement of seizure type was moderate (κ = 0.44), with primary generalised seizures showing the highest level of agreement (κ = 0.60), and focal the lowest (κ =0.31). Fair agreement was found for consciousness status and the presence of autonomic signs (κ = 0.21-0.40), but poor agreement for neurobehavioral signs (κ = 0.16). Agreement for motor signs ranged from poor (κ = ≤ 0.20) to moderate (κ = 0.41-0.60). Differences between specialists and non-specialists were identified.
  
  
  CONCLUSIONS
  The relatively low levels of agreement described here highlight the need for further discussions between neurology experts regarding classifying and describing epileptic seizures, and additional training of non-specialists to facilitate accurate diagnosis. There is a need for diagnostic tools (e.g. electroencephalogram) able to differentiate between epileptic and non-epileptic paroxysms.
authors.affiliation: Department of Clinical Science and Services, Royal Veterinary College, Hertfordshire, UK. rpacker@rvc.ac.uk.
authors.forename: Rowena M A
authors.initials: RM
authors.lastname: Packer
authors.affiliation: Department of Veterinary Clinical and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark. mbe@sund.ku.dk.
authors.forename: Mette
authors.initials: M
authors.lastname: Berendt
authors.affiliation: Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium. sofie.bhatti@ugent.be.
authors.forename: Sofie
authors.initials: S
authors.lastname: Bhatti
authors.affiliation: Cornell University College of Veterinary Medicine, Ithaca, New York, USA. mariosdvm@gmail.com.
authors.forename: Marios
authors.initials: M
authors.lastname: Charalambous
authors.affiliation: The Referral Animal Neurology Hospital "Aisti", Vantaa, Finland. sigitas.cizinauskas@aisti.info.
authors.forename: Sigitas
authors.initials: S
authors.lastname: Cizinauskas
authors.affiliation: Animal Health Trust, Lanwades Park, Newmarket, UK. luisa.derisio@aht.org.uk.
authors.forename: Luisa
authors.initials: L
authors.lastname: De Risio
authors.affiliation: Fernside Veterinary Centre, Hertfordshire, UK. robyn.fernside@googlemail.com.
authors.forename: Robyn
authors.initials: R
authors.lastname: Farquhar
authors.affiliation: Department of Clinical Science and Services, Royal Veterinary College, Hertfordshire, UK. rhampel@rvc.ac.uk.
authors.forename: Rachel
authors.initials: R
authors.lastname: Hampel
authors.affiliation: Department of Clinical Science and Services, Royal Veterinary College, Hertfordshire, UK. mfeh3@cam.ac.uk.
authors.forename: Myfanwy
authors.initials: M
authors.lastname: Hill
authors.affiliation: Department of Clinical Sciences of Companion Animals, Utrecht University, Utrecht, The Netherlands. P.J.J.Mandigers@uu.nl.
authors.forename: Paul J J
authors.initials: PJ
authors.lastname: Mandigers
authors.affiliation: University Clinic for Small Animals, Clinical Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria. akos.pakozdy@vetmeduni.ac.at.
authors.forename: Akos
authors.initials: A
authors.lastname: Pakozdy
authors.affiliation: Department of Clinical Science and Services, Royal Veterinary College, Hertfordshire, UK. spreston@rvc.ac.uk.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Preston
authors.affiliation: School of Veterinary Medicine, Faculty of Health & Medical Sciences, University of Surrey, Surrey, UK. ClareR@fitzpatrickreferrals.co.uk.
authors.forename: Clare
authors.initials: C
authors.lastname: Rusbridge
authors.affiliation: Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Buenteweg 9, 30559, Hannover, Germany. Veronika.Stein@tiho-hannover.de.
authors.forename: Veronika M
authors.initials: VM
authors.lastname: Stein
authors.affiliation: Department of Clinical Science and Services, Royal Veterinary College, Hertfordshire, UK. ftaylor@rvc.ac.uk.
authors.forename: Fran
authors.initials: F
authors.lastname: Taylor-Brown
authors.affiliation: Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Buenteweg 9, 30559, Hannover, Germany. Andrea.Tipold@tiho-hannover.de.
authors.forename: Andrea
authors.initials: A
authors.lastname: Tipold
authors.affiliation: Department of Clinical Science and Services, Royal Veterinary College, Hertfordshire, UK. hvolk@rvc.ac.uk.
authors.forename: Holger A
authors.initials: HA
authors.lastname: Volk
mesh_terms: D000818:Animals; D001341:Autonomic Nervous System / Q000503:physiopathology; D001522:Behavior, Animal / Q000502:physiology; D002371:Cat Diseases / Q000145:classification / Q000175:diagnosis*; D002415:Cats; D004283:Dog Diseases / Q000145:classification / Q000175:diagnosis*; D004285:Dogs; D009068:Movement / Q000502:physiology; D015588:Observer Variation; D012640:Seizures / Q000145:classification / Q000175:diagnosis / Q000662:veterinary*; D018634:Veterinarians / Q000706:statistics & numerical data; D014730:Veterinary Medicine; D014741:Video Recording