YouTube as a potential learning tool to help distinguish tonic–clonic seizures from nonepileptic attacks
Introduction
Epilepsy is the most common serious neurological condition, affecting approximately 50.4 people/100,000/year [1]. Most junior doctors will, at some point, encounter a patient having a seizure either in the wards, in the emergency department, or in general practice. Status epilepticus is a life-threatening emergency with an estimated mortality approaching 15% [2]. Prompt recognition and treatment of a seizure is vital to optimize outcome. However, up to a fifth of patients referred to epilepsy centers suffer from psychogenic nonepileptic seizures [3]. Nonepileptic seizures are often mistaken for generalized tonic–clonic seizures, with about a quarter of referrals to neurological intensive care units for refractory status epilepticus found to be “pseudostatus” [4]. Clinicians, therefore, may subject patients suffering from nonepileptic seizures to unnecessary, expensive, and potentially harmful medical interventions [5].
Today, many medical students and qualified doctors use the Internet as a learning resource to help recognize different clinical signs and syndromes [6]. Likewise, the general public will often access the Internet to learn more about medical conditions. As different seizure types can be distinguished based on the characteristic behavior of a patient during an event, video examples have the potential to be extremely useful educational aids in understanding epilepsy and differentiating seizure types.
YouTube (www.youtube.com) is currently ranked as the second most visited website in the world and holds a vast collection of videos claiming to demonstrate different types of medical events, including various forms of epileptic seizures [7]. Previous studies have investigated the quality of other YouTube videos of relevance to neurology, including the following: movement disorders [8], West syndrome [9], and the correct technique for performing lumbar puncture [10]. Each of these studies found the videos on YouTube to be inaccurate and has advised against their use as a learning resource without stringent supervision from a specialist. As the potential adverse effect from junior doctors incorrectly classifying paroxysmal events as either epileptic or nonepileptic in origin is great, we investigated the accuracy of YouTube videos claiming to show different seizure types. In particular, we wished to study whether nonepileptic events could be clearly differentiated from epileptic seizures and if the type of seizure returned following a search term concurred with the classification that an epileptologist would apply. We also wished to determine if it was possible to identify certain YouTube videos that could be recommended for medical students to help them differentiate epileptic from nonepileptic events.
Section snippets
Methods
We reviewed YouTube videos claiming to show different types of epileptic seizures. Two consultant neurologists with a special interest in epilepsy independently assessed the top YouTube videos returned following searches based loosely around the International League Against Epilepsy (ILAE) classification of seizure events (Fig. 1) [11]. The videos were rated for their technical quality, accuracy, and efficacy as a learning tool for medical education. We aimed to determine the accuracy of
Results
In total, 4368 videos were obtained across the 8 search terms. The first 25 videos of each search term were retained. The mean number of viewings of each of the 200 videos was 33,866 views, with a range from 58 to 835,659. The application of inclusion and exclusion criteria resulted in the exclusion of 74 videos. During the study period, 20 videos meeting the inclusion criteria were removed from YouTube leaving 106 videos that were assessed for technical quality, concordance of YouTube with the
Discussion
The present study attempted to recreate the conditions under which a medical student or practicing clinician may seek videos demonstrating different epileptic seizure types. The general public and patients are also likely to access YouTube videos in a similar way, particularly if a specific diagnostic label has been given to their events, such as myoclonus. Eight terms relating to different categories of seizures were searched, and the top 25 results for each search term were retained, yielding
Conclusions
This study suggests that the majority of videos on YouTube claiming to show specific seizure subtypes are inaccurate and that YouTube should not be recommended as a learning tool for students to learn about types of seizure disorders. A small group of videos provides very good examples of tonic–clonic and nonepileptic seizures, and these could be used by an epileptologist to illustrate the difference between epileptic and nonepileptic seizures. Although outside the scope of the current project,
Conflict of interest statement
There are no conflicts of interest pertaining to any of the authors.
Acknowledgments
The study was sponsored by the Oxford Biomedical Research Centre and by the University of Oxford.
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