title: Human bedside evaluation versus automatic responsiveness testing in epilepsy (ARTiE).
abstract: Evaluation of behavioral impairment during epileptic seizures is critical for medical decision making, including accurate diagnosis, recommendations for driving, and presurgical evaluation. We investigated the quality of behavioral testing during inpatient video-electroencephalography (EEG) monitoring at an established epilepsy center, and introduce a technical innovation that may improve clinical care. We retrospectively reviewed video-EEG data from 152 seizures in 33 adult or pediatric patients admitted for video-EEG monitoring. Behavioral testing with questions or commands was performed in only 50% of seizures ictally, 73% of seizures postictally, and 80% with either ictal or postictal testing combined. Furthermore, the questions or commands were highly inconsistent and were performed by nonmedical personnel in about one fourth of cases. In an effort to improve this situation we developed and here introduce Automatic Responsiveness Testing in Epilepsy (ARTiE), a series of video-recorded behavioral tasks automatically triggered to play in the patient's room by computerized seizure detection. In initial technical testing using prerecorded or live video-EEG data we found that ARTiE is initiated reliably by automatic seizure detection. With additional clinical testing we hope that ARTiE will succeed in providing comprehensive and reliable behavioral evaluation during seizures for people with epilepsy to greatly improve their clinical care.
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, U.S.A.
authors.forename: George
authors.initials: G
authors.lastname: Touloumes
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, U.S.A.
authors.forename: Elliot
authors.initials: E
authors.lastname: Morse
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, U.S.A.
authors.forename: William C
authors.initials: WC
authors.lastname: Chen
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, U.S.A.
authors.forename: Leah
authors.initials: L
authors.lastname: Gober
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, U.S.A.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Dente
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, U.S.A.
authors.forename: Rachel
authors.initials: R
authors.lastname: Lilenbaum
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, U.S.A.
authors.forename: Emily
authors.initials: E
authors.lastname: Katzenstein
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, U.S.A.
authors.forename: Ashley
authors.initials: A
authors.lastname: Pacelli
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, U.S.A.
authors.forename: Emily
authors.initials: E
authors.lastname: Johnson
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, U.S.A.|Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Si
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, U.S.A.
authors.forename: Adithya
authors.initials: A
authors.lastname: Sivaraju
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, U.S.A.
authors.forename: Eric
authors.initials: E
authors.lastname: Grover
authors.affiliation: Yale-New Haven Hospital, New Haven, Connecticut, U.S.A.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Khozein
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, U.S.A.
authors.forename: Courtney
authors.initials: C
authors.lastname: Cunningham
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, U.S.A.
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Hirsch
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, U.S.A.|Department of Neuroscience, Yale University School of Medicine, New Haven, Connecticut, U.S.A.|Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A.
authors.forename: Hal
authors.initials: H
authors.lastname: Blumenfeld
mesh_terms: D000328:Adult; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000209:etiology*; D008991:Monitoring, Physiologic; D014741:Video Recording; D055815:Young Adult
keywords: Behavioral testing; Consciousness; Driving; Epilepsy; Seizure detection