Concordance Between Patient-Reported And Physician-Reported Seizure Semiology

Objective: The objective of this study is to evaluate the concordance of patient-reported seizure semiology with physician-reported semiology. Background: Recognizing and describing seizure semiology is crucial in the diagnosis, evaluation, and management of epilepsy and is essential in pre-surgical evaluation for intractable epilepsy. Design/Methods: Chart data from 201 patients during their epilepsy monitoring unit (EMU) evaluations from October 2016 to October 2017 were retrospectively reviewed. Seizure semiology described by patients was compared to physician-reported semiology during the EMU stay. Semiology was scored across categories: aura, onset, motor and non-motor features, and postictal states, as well as their characteristics. Patients with non-diagnostic EMU evaluations were excluded due to inability to compare patient and physician descriptions of semiology. Results: Statistical analysis for concordance using Cohen’s kappa coefficient was conducted across the categories for 128 of 201 patients. Four categories were in moderate agreement: presence or absence of focal non-motor spell and its characteristics with kappa scores of 0.54 and 0.45, respectively; presence or absence of focal motor spell and its characteristics with scores of 0.56 and 0.41, respectively; presence or absence of generalized motor spell and its characteristics with scores of 0.60 and 0.59, respectively; and presence or absence of generalized non-motor spell and its characteristics with scores of 0.50 and 0.51, respectively. The remaining two categories were in fair agreement: presence or absence of aura and its characteristics with scores of 0.33 and 0.37, respectively; and presence or absence of postictal state and its characteristics with scores of 0.30 and 0.23, respectively. Each score had a p-value of less than 0.01. Conclusions: Concordance of patient-reported and physician-reported semiology varies widely but agreement is higher for categories pertaining to ictal state compared to preictal and postictal states. Further studies are needed to determine if improved concordance is a positive prognostic factor for post-treatment seizure freedom. Disclosure: Dr. Lin has nothing to disclose. Mr. Arraj has nothing to disclose. Dr. Agostini has nothing to disclose. Dr. Alick has nothing to disclose. Dr. Das has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for janicek. The institution of an immediate family member of Dr. Das has received research support from NIH. Dr. Dave has nothing to disclose. Dr. Dieppa has nothing to disclose. The institution of Dr. Ding has received research support from National Institute of Aging. The institution of Dr. Ding has received research support from NINDS. The institution of Dr. Ding has received research support from Darrell K Royal Research Fundation. Dr. Harvey has received personal compensation for serving as an employee of RSC Diagnostics. The institution of Dr. Harvey has received research support from UCB Pharmaceuticals. The institution of Dr. Harvey has received research support from Biogen Pharmaceuticals. Dr. Hays has nothing to disclose. Dr. Perven has nothing to disclose. irina podkorytova has nothing to disclose. Dr. Zepeda Garcia has nothing to disclose. Dr. Doyle has nothing to disclose.