Novel Smartphone-Based Screening Tool for Absence Seizures in Pediatric Settings: A Comparative Study With Video EEG.

BACKGROUND: Staring spells, a common chief complaint in pediatrics, lead to both over-referral and under-referral to neurologists, creating significant challenges in clinical care. Children with nonepileptic staring episodes are frequently referred unnecessarily to neurology, while children with Childhood Absence Epilepsy are commonly misdiagnosed with disorders such as attention-deficit/hyperactivity disorder (ADHD). Hyperventilation (HV) has long been used as a neurobehavioral tool to provoke and diagnose absence seizures in children with suspected Childhood Absence Epilepsy. We evaluated the Eysz HV Recorder, a smartphone-based tool that guides children through HV while capturing video, as a screening tool for absence seizures.

METHODS: Sixty participants underwent HV using the HV Recorder during electroencephalography observation. Two independent, blinded panels of three epileptologists each reviewed the data as follows: one panel reviewed the video electroencephalography (vEEG) and the other reviewed the HV Recorder video. We assessed the HV Recorder reviewers' ability to detect seizures compared to the vEEG reviews.

RESULTS: HV Recorder reviewers had 100% sensitivity and 91% specificity for identifying absence seizing patients with seizures ≥7 s. Individual seizures were detected with 96% sensitivity for seizures ≥7s and 86% across seizures of all lengths. Agreement levels were similar between epileptologists reviewing the vEEG and the HV Recorder video (vEEG-vEEG: 90%, HV-HV: 87%, HV-vEEG: 82%). Reviewers reported they could clearly identify clinical events from the HV Recorder video more often than the vEEG video.

CONCLUSIONS: The Eysz HV Recorder is an accurate tool with high sensitivity and specificity for identifying absence seizures, which could aid clinicians in differentiating epileptic from nonepileptic staring spells.