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Abstract Details

Quantifying the Impact of Computer-aided Diagnostic Score on the Diagnosis of Functional Seizures
Epilepsy/Clinical Neurophysiology (EEG)
S29 - Epilepsy Diagnostics and Therapeutics (2:36 PM-2:48 PM)
009

The diagnosis of FS (also known as psychogenic nonepileptic seizures [PNES]) without ictal video-electroencephalography is challenging. Delayed and inaccurate diagnosis has been associated with worse long-term treatment outcomes. The Functional Seizures Likelihood Score (FSLS) is a machine learning-based diagnostic that identifies patients with probable FS.

We evaluated if our machine learning-derived score improved the ability of seizure specialists and non-seizure specialists in accurately identifying functional seizures (FS) as compared to epilepsy based on information available prior to ictal video-electroencephalography.

117 anonymized cases were constructed using data from patients with documented FS, epilepsy, mixed epileptic and FS, or physiologic seizure-like events. Data were presented sequentially, showing the history of present illness (HPI), followed by FSLS (in 50% of cases), electroencephalogram (EEG), and imaging (MRI). Clinician-participants were asked the most likely diagnosis after viewing each sequential piece of data. We evaluated the impact of level of expertise in seizures and of each piece of data using mixed-effects logistic regression.

Participants saw 1,057 cases, with a median of 3.5 cases per person [interquartile range: 1-7], with 28% of participants viewing only one case. Based on the HPI alone, seizure-specialists’ accuracy was significantly higher than non-seizure specialists (68.2% vs 51.7%, p=0.02), and not statistically different from the FSLS without human review (78.6%, p=0.06). Non-specialists’ accuracy improved with the FSLS (56.7%, Odds Ratio 1.54, p=0.05), but specialists’ accuracy did not (68.0%, Odds Ratio 0.74, p=0.31). For all participants, diagnostic accuracy increased when viewing more data (OR: 1.33 FSLS, 1.41 EEG, 1.53 MRI, and p=0.09, 0.046, 0.01, respectively).

The FSLS improved non-seizure specialists’ diagnosis of FS but did not improve seizure specialists’ diagnosis. Therefore, implementation of the FSLS may focus on utilization by non-seizure specialists to reduce delays to referral to seizure specialists and thereby accurate diagnosis.

Authors/Disclosures
Katherine McFarlane (University of Pittsburgh)
PRESENTER
Ms. McFarlane has nothing to disclose.
No disclosure on file
Samuel Terman (University of Michigan, Neurology Dept) Dr. Terman has received research support from American Epilepsy Society. Dr. Terman has received research support from Epilepsy Study Consortium. Dr. Terman has received research support from New York University. Dr. Terman has received personal compensation in the range of $100,000-$499,999 for serving as a clinician scientist trainee for Susan S Spencer award with American Academy of Neurology.
Sung Hyun Seo (University of Michigan) Dr. Seo has nothing to disclose.
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Meagan Watson (University of Colorado) Ms. Watson has nothing to disclose.
No disclosure on file
John Stern Dr. Stern has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for UCB Pharma. Dr. Stern has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for SK Life Science. Dr. Stern has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Neurelis. Dr. Stern has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Ceribell. Dr. Stern has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Jazz Pharma. Dr. Stern has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for LivaNova. Dr. Stern has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Neurelis. Dr. Stern has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for LivaNova. Dr. Stern has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Sunovion. Dr. Stern has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Jazz. Dr. Stern has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for SK Life Sciences. Dr. Stern has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for MedLink Neurology. Dr. Stern has stock in DEARhealth. Dr. Stern has stock in Ceribell. Dr. Stern has received publishing royalties from a publication relating to health care. Dr. Stern has received publishing royalties from a publication relating to health care. Dr. Stern has received publishing royalties from a publication relating to health care. Dr. Stern has received publishing royalties from a publication relating to health care.
No disclosure on file
Laura Strom (University of Colorado-Denver) Dr. Strom has nothing to disclose.
William Stacey (University of Michigan) No disclosure on file
Wesley Kerr (University of Pittsburgh) Dr. Kerr has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for SK Lifesciences. Dr. Kerr has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biohaven Pharmaceuticals. Dr. Kerr has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EpiTel. Dr. Kerr has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Kerr has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biohaven Pharmaceuticals. Dr. Kerr has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerebral Therapeutics. Dr. Kerr has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Epilepsia. The institution of Dr. Kerr has received research support from NINDS. The institution of Dr. Kerr has received research support from American Epilepsy Society. The institution of Dr. Kerr has received research support from American Academy of Neurology. Dr. Kerr has received publishing royalties from a publication relating to health care.