Wartość monitorowania wideo w klasyfikacji napadów padaczki i wyborze leków - badanie ankietowe u pacjentów ambulatoryjnych

OBJECTIVE: To evaluate the clinical value of ictal video monitoring in refining seizure classification and guiding antiseizure medication (ASM) decisions in outpatients with epilepsy, and to examine the concordance between eyewitness descriptions and objective video evidence. METHODS: In this questionnaire-based, single-center study, 525 patients with epilepsy who attended the neurology outpatient clinic of West China Hospital, Sichuan University, between July and September 2025 were enrolled. A self-designed questionnaire was used to collect demographic information, medication history, seizure types, eyewitness descriptions, ictal video recordings, and diagnostic classifications before and after video review. Patients with ictal videos were grouped by recording modality: mobile phone recording, surveillance footage, and video-EEG (VEEG) monitoring. Initial classification was performed without video; a second classification was then performed with video when available. Classifications were independently reviewed once by an experienced epilepsy-specialist neurologist, with final adjudication by a senior physician in cases of disagreement.Categorical variables were compared using the χ2 test or Fisher's exact test when expected frequencies were < 5, with two-sided P < 0.05 considered statistically significant. RESULTS: Ictal video recordings were available for 159 of 525 patients (30.3 %). Among the 159 patients with complete pre- and post-video diagnostic records, diagnostic revision occurred in 32 patients (20.1 %). The most common revision pathway was bilateral tonic-clonic seizure of unknown onset (BTC) to focal-to-bilateral tonic-clonic seizure (FBTC), accounting for 46.9 % (15/32) of all revisions. A determinate final seizure classification (focal or generalized) was more frequent in patients with ictal videos than in those without (96/159 [60.4 %] vs 121/366 [33.1 %], P < 0.001). ASM regimens were changed based on video evidence in 19/159 patients (11.9 %), and 16 patients required subsequent readjustment. Diagnostic revision rates were 15.2 % (19/125) for mobile phone recordings, 36.8 % (7/19) for surveillance footage, and 40.0 % (6/15) for VEEG monitoring. Diagnostic revision was significantly associated with ASM regimen changes (χ = 4.22, P = 0.040). An eyewitness was present at consultation for 512/525 patients (97.5 %), and the diagnostic concordance rate between eyewitness descriptions and video evidence was 89.9 %. CONCLUSION: Ictal video recording was associated with clinically meaningful revision of seizure classification and influenced ASM decisions in outpatients with epilepsy, with higher diagnostic yield observed for more professional recording modalities. Video evidence may help correct classification bias arising from reliance on verbal history, particularly in identifying focal onset.