Feasibility and accuracy of teleconcussion for acute evaluation of suspected concussion.

OBJECTIVE: To assess the feasibility and accuracy of telemedical concussion evaluations (teleconcussion) for real-time athletic sideline assessment of concussion, as such assessment may address the gap in access some populations of athletes have to providers with expertise in concussion evaluation. METHODS: A cohort of 11 consecutive male collegiate football players with suspected concussion was assessed using Standardized Assessment of Concussion (SAC), King-Devick test (K-D), and modified Balance Error Scoring System (mBESS). A remote neurologist assessed each athlete using a telemedicine robot with real-time, 2-way audiovisual capabilities, while a sideline provider performed a simultaneous face-to-face assessment. After the assessment, a remove-from-play (RFP) determination was made. The remote and the face-to-face providers were blinded to each other's examination findings and RFP decision until the end of the assessment. RESULTS: The teleconcussion and face-to-face SAC were in agreement 100% of the time (6/6; 95% confidence interval [CI] 54%-100%). The mean (SD) difference between remote and sideline K-D times was 0.7 (1.4) seconds. Remote and sideline K-D times were within a 3-second difference 100% of the time (11/11; 95% CI 72%-100%). Remote and sideline mBESS scores were within 3 points 100% of the time (6/6; 95% CI 54%-100%). RFP decisions were in agreement 100% of the time (11/11; 95% CI 72%-100%). CONCLUSIONS: The aim of this study was to investigate the feasibility of teleconcussion for sideline concussion assessments. These data suggest a high level of agreement between remote and face-to-face providers with regard to examination findings and RFP determinations.

Patients with psychogenic nonepileptic seizures report more severe migraine than patients with epilepsy.

PURPOSE: Clinical observations suggest that psychogenic non-epileptic seizure (PNES) patients often have severe migraine, more severe than epilepsy patients. Investigations into migraine characteristics in patients with PNES are lacking. In this study we tested the hypothesis that, compared to epilepsy patients, PNES patients have more severe migraine, with more frequent and longer duration attacks that cause greater disability. METHOD: In this observational study, 633 patients with video-EEG proven epilepsy or PNES were identified from the Mayo Clinic Epilepsy Monitoring Unit database. Contacted patients were screened for migraine via a validated questionnaire, and when present, data regarding migraine characteristics were collected. Two-sample t-tests, chi square analyses, and Mann-Whitney U tests were used to compare migraine characteristics in PNES patients to those of epilepsy patients. RESULTS: Data from 43 PNES patients with migraine and 29 epilepsy patients with migraine were available. Compared to epilepsy patients, PNES patients reported having more frequent headaches (mean 15.1 ± 9.8 vs. 8.1 ± 6.6 headache days/month, p<.001), more frequent migraine attacks (mean 6.5 ± 6.3 vs. 3.8. ± 4.1 migraines/month, p=.028), longer duration migraines (mean 39.5 ± 28.3 vs. 27.3 ± 20.1h, p=.035), and more frequently had non-visual migraine auras (78.6% vs. 46.7% of patients with migraine auras, p=.033). Migraine-related disability scores were not different between PNES and epilepsy patients (median 39, interquartile range 89 vs. 25, interquartile range 60.6, p=.15). CONCLUSION: Compared to epilepsy patients with migraine, PNES patients with migraine report having a more severe form of migraine with more frequent and longer duration attacks that are more commonly associated with non-visual migraine auras.