title: The semiology of psychogenic nonepileptic seizures revisited: Can video alone predict the diagnosis? Preliminary data from a prospective feasibility study.
abstract: OBJECTIVE
  To investigate if, when, and to what extent visual information contained in a video-recorded event allows experienced epileptologists to predict the diagnosis of psychogenic nonepileptic seizures (PNES) without the aid of electroencephalography (EEG).
  
  
  METHODS
  Five neurologists actively practicing in epilepsy centers in Italy and the United States were asked to review 23 videos capturing representative events of 21 unselected consecutive patients admitted for long-term video-EEG monitoring (VEM). Four raters were blind to EEG and clinical information; one rater was not. They were requested to (1) rate the videos for quality and content; (2) choose among four diagnoses: (a) epileptic seizures (ES); (b) PNES; (c) Other nonepileptic seizures (NES; (syncope, movement disorder, migraine, etc.); (d) "Cannot Say"; and (3) explain in their own words the main reasons leading to the diagnosis of choice.
  
  
  RESULTS
  All raters predicted the diagnosis correctly in 7 of 23 videos (all ES or PNES) (30.4%), whereas all raters failed in 5 of 23 cases (three Other NES, one PNES, one Cannot Say) (21.7%). The conditions that facilitate, and those that interfere with, a confident diagnosis were predictable. Degree of accuracy among raters was not uniform and was consistently better in three raters. Two among the four blind raters were as accurate as the rater who was not blinded. Interrater agreement was "moderate" (k = 0.52) for the overall group; "moderate" for ES (k = 0.53); "substantial" for PNES (k = 0.63); "fair" for Other NES (k = 0.21)-similar to the results obtained in a previous study evaluating the reliability of combined video-EEG.
  
  
  CONCLUSIONS
  In about one third of cases, a confident diagnosis of PNES/ES can be established on clinical grounds based on video data alone. Our results benefit all affected patients, particularly those with no access to video-EEG monitoring units.
authors.affiliation: Department of Neurology, SEC, University of Rochester, Rochester, New York, U.S.A.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Erba
authors.affiliation: Laboratory of Neurological Disorders, Department of Neuroscience, IRCCS-Pharmacological Research Institute "Mario Negri", Milan, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Giussani
authors.affiliation: Department of Neurology, SEC, University of Rochester, Rochester, New York, U.S.A.
authors.forename: Adam
authors.initials: A
authors.lastname: Juersivich
authors.affiliation: Department of Neuroscience, Epilepsy Center, University of Messina, Messina, Italy.
authors.forename: Adriana
authors.initials: A
authors.lastname: Magaudda
authors.affiliation: Neurology Unit 2, Epilepsy Center, San Paolo Hospital, Milan, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Chiesa
authors.affiliation: Department of Neuroscience, Epilepsy Center, University of Messina, Messina, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Laganà
authors.affiliation: Department of Pediatric, Gynecological, Microbiological and Biomedical Science, Unit of Infantile Neuropsychiatry, University of Messina, Messina, Italy.
authors.forename: Gabriella
authors.identifier: http://orcid.org/0000-0003-3061-3249
authors.initials: G
authors.lastname: Di Rosa
authors.affiliation: Laboratory of Neurological Disorders, Department of Neuroscience, IRCCS-Pharmacological Research Institute "Mario Negri", Milan, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Bianchi
authors.affiliation: Department of Neurology, SEC, University of Rochester, Rochester, New York, U.S.A.
authors.forename: John
authors.initials: J
authors.lastname: Langfitt
authors.affiliation: Laboratory of Neurological Disorders, Department of Neuroscience, IRCCS-Pharmacological Research Institute "Mario Negri", Milan, Italy.
authors.forename: Ettore
authors.initials: E
authors.lastname: Beghi
mesh_terms: D000328:Adult; D003291:Conversion Disorder / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D003937:Diagnosis, Differential; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011602:Psychophysiologic Disorders / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D013223:Statistics as Topic; D014741:Video Recording
keywords: Epileptic seizures; Monitoring; Nonepileptic seizures; Psychogenic seizures; Semiology; Video